Here is Alyssa's story in her own words:

This is what we were trained for.

My journey from the world of outpatient orthopedics in Michigan to emergency medicine
on the COVID frontlines in New York City began with one unexpected and brief conversation at
the end of March from a great friend and PA mentor, Stacie Graves Skiano, PA-C. She said,
“I’m on my way to New Orleans to help with the COVID crisis... I can’t just sit at home and do
nothing. You should look into it and maybe you can come too. I feel like this is what we were
trained for.” That brief conversation sparked a fire in my soul. The phrase “this is what we were
trained for” kept running through my mind.

At the time I applied to work on the frontlines, the need had shifted to New York City.
The thought of going to NYC was intimidating and frankly quite frightening, but with each
passing moment I felt increasingly compelled to go. Within 48 hours I was on a flight from DTW
into the world of the unknown.

Six years ago, on the first day of my PA program, I would have never believed I would
be here today. Yet here I am among the thousands of other frontline workers, working endless
hours in the mission to care for the most vulnerable humans affected by COVID-19. It is an
incredible honor and privilege to be able to both represent my profession and offer assistance in
this time of need. How humbling it is to work alongside some of the most incredible medical
providers and join with them in their fight against this pandemic. This is, in my opinion, one of
the greatest things about being a PA - we are trained to be adaptable and to meet the needs of
any medical specialty.

My assignment was to the emergency department of a busy hospital in Bronx, NY. The
tour I received on my first shift demonstrated the dire need of an influx of healthcare providers.
The emergency department was overflowing with patients. The ED pods were filled with
stretchers of intubated patients and patients on non-invasive ventilation. Ambulatory patients
were seated in chairs while receiving treatment. Most floors of the hospital had been converted
to intensive care units. There were holes drilled through the walls to keep IV lines and
drips/pumps outside the patient rooms to avoid unnecessary room entrances and exposures to
healthcare providers as any exposure is a possibility of viral transmission. Video monitors were
used to monitor patients from outside their rooms. The floors were filled to such capacity that
the ED was backed up with admitted patients waiting for a bed upstairs to become available.
Evaluating new patients seemed to just be case after case of COVID. At first, testing
was limited to admitted patients only. Patients stable for discharge home were treated on a
presumptive diagnosis based on chest x-ray results, oxygen level, and clinical symptoms.
I began to see first hand the rage this disease has on the people and community
affected. Young or old, healthy or sick, COVID seemed to arbitrarily attack some people more
voraciously than others. I listened as providers recounted their experiences with patients
decompensating quickly - making me nervous about decisions regarding who I would discharge
home versus who I would admit.

I witnessed patients come to the ED alone and afraid after suffering for a week or longer
at home until they could no longer bear their symptoms. They didn’t want to come into the
hospital and face the likelihood they might die alone. Their family members were not allowed
inside. They were met by hospital staff covered from head to toe in personal protective
equipment. They conversed with their healthcare providers through a barrier of masks and face
shields, gowns and gloves. The personal touch of human interaction stifled by the necessary
precautions to avoid disease transmission. I reminded myself that I can’t help others if I become
a COVID casualty. I faced my own mortality as I engaged in patient care daily. I understood the
risks but pledged to do my best to protect myself while engaging in my mission to combat
COVID-19 every day.

There was a near palpable weight felt each day as I entered the ED area fully knowing
that any patient I encountered that day could (and likely would) have COVID. By the end of my
shifts I was fatigued from the extensive PPE I wore for 12 hours each day. I avoided removing
my mask to drink water during my shift for fear of contaminating myself. My face hurt from the
pressure of wearing my N95 all day. Strangely enough, I was thankful for that discomfort
because it was a reminder of the protection my equipment offered me from this virus.
As the case numbers began to plateau and decline we were left wondering what was
next. Would there be a quick second surge? Would we be inundated with other medical
emergencies? Would people just stay home and decline to seek medical care? The explosive
blast of that first wave was over, but the shattered debris of NYC began to settle and the
assessment of covidlateral damage (medical, psychiatric, and economic problems occuring on
the periphery of the COVID pandemic) began. How would the local healthcare workers hold up
after weeks of intense mass influx patient care? How could we continuously adapt our patient
care to improve outcomes? The only consistent thing to do was to return each day to the ED to
see what that day would have in store.

As my career as a PA has thus far been strictly in the outpatient orthopedic surgery
realm, I found the ED to be somewhat of a medical culture shock. I needed to very quickly learn
the hospital’s patient flow, electronic medical record, available resources, as well as reorient
myself to the thought patterns utilized in assessing and treating a patient in the emergency
medicine setting.

The words of my mentor kept replaying in my head, “this is what we were trained for.” I
was trained as a PA to treat patients with respect and dignity while providing the best possible
medical care. I was trained to take a good history and evaluate a patient thoroughly. I was
trained to recognize a sick person and advocate for them. I was trained to have good clinical
decision making skills and to utilize appropriate medical resources for additional guidance and
information. I was trained to be a part of a collaborative healthcare system and work together
with a team of doctors and nurses and support staff. I was trained to recognize my own
limitations in knowledge and utilize the vast knowledge of those around me.
Never in my life did I imagine I’d be fighting a pandemic as part of an incredible team of
healthcare providers, and never in my life have I been more proud to be a part of a collective
effort to help those who need it most. I am especially thankful for the doctors here who trust me
to provide care for their patients and who have embraced me as a teammate in this battle
against COVID-19. I am forever grateful to all those who have supported this effort.

I've heard this and said it a bunch over the last week! I hope the New Year is good for you and you are able to keep your resolutions!

I have several goals:

• Do a better job at writing this blog and for articles for the Orthopedics Today

• Start a podcast

• Expand PAOS CARES outreach program

• Have 3 successful meetings

• Have our first ever MSK U/S workshop (which will be a stand alone workshop later in the fall of 2020-stay tuned)

• And as always play more golf!!

This is just a quickie blog post, but I wanted to thank each and every one of our members for supporting us and helping us keep our organization rolling. I also want to throw a big thank you out to all of our BOD and those who do work for our BOD - we could not be a successful organization without you!

I hope you all have a safe and prosperous New Year! Don't forget to look to us for your CME needs, conferences or online content.

Sam

I am glad to be home again-it was a long week away in San Antonio. We spent many hours working and meeting, and some down time for fun. Just a recap of a few meeting highlights:

• We had over 25 hours of conference presentations covering a wide variety of orthopedic topics.
• There were several workshops including fracture fixation, MSK ultrasound, casting and splinting, graft prep, a cadaver wet lab, and bone health. There was also an update on coding and billing.
• Many attendees spent some time on the property at the lazy river water park.
• We had 36 golfers participate in a scramble on the AT&T Oaks course.
  
• There was a tequila tasting night and a guided walk through the woods (this is a large property).
• We had bus shuttles taking attendees to the river walk/Alamo for some R and R.
• There were numerous sponsored meals both by the PAOS and industry as well as a welcome reception for attendees and active/retired military.
  

And a recap of PAOS board meeting and board networking:

• I am happy to announce that the SLM scholarships are now funded for 15 years-even if we don't contribute any more money to it (we will continue donating money as long as we can, FYI).
  
• We are working on a plan to make the scholarships sustainable forever and possibly increasing the awards down the road.
• We raised $2200 from San Antonio golf outing games and an Ipad raffle with 100% of proceeds going to the SLMS.
• We received a record number of student scholarship applicants this year (66). These were narrowed to the top 6 and presented to the BOD to choose the top two (see next bullet). As all six were outstanding, the PAOS BOD and scholarship committee decided to award consolation prizes of two years of membership to the 3rd-6th place applicants.
• Congratulations to Miguel Serrato MS, PA-S, ATC, OTC, and Liana Berkowitz PA-S1, ATC, LAT, CSCS who were the scholarship winners this year. Each received a $5000 award and were flown out to the meeting to receive their awards and present their work.
• As an organization, we are fiscally sound and will be meeting with financial advisors to help guide us toward long term viability.
• I met with many industry representatives and all are interested in supporting PAs in ortho. I hope that this will translate into better future offerings for our conferences and educational platforms both hands on and online.
  
• As is customary for the PAOS, we donated $5000 to a local charity-this year the Fisher House of San Antonio. Erik Zielinski, manager of the San Antonio Fisher House made a presentation to the attendees about the Fisher house program and what it does. Here is a link to the local program.
• There were several poster presentations and all were outstanding. I am so proud of this work and that it has grown so much in the last few years. We also voted to award 1st 2nd and 3rd place prizes for those voted the best by the CME committee. Congratulations Captain John Gagnier, MPAS, PA-C, Captain Tania Didas, MPAS, PA-C, and Major Tyson Baines, MPAS, PA-C.
  
• We are having a special election for the south central regional director position-this announcement will be mailed to members in the region soon. Look for an opportunity to vote on this in the next few weeks.
• We plan to continue the annual practice and salary survey indefinitely in its current format. We also have assigned two board members to review the content and questions to try and make it even more meaningful to members.

I think that covers most everything. There is so much work from so many people to make these meetings happen, I would be remiss not to thank them. At the risk of leaving anyone out, let me just say thank you to everyone who played a part in making this meeting successful and helping to grow and educate our membership. I'm already looking forward to Denver!

Take care,

Sam

Lazy river, water slides, fun!!

Greetings! I wanted to write a quick blog entry while I am in between patients. I am so excited to go to this meeting! It is such a beautiful place and a fun and relaxing time. I also looked at the website for the Marriott; the current rack rate is $479 a night. How much for PAOS attendees in our block? $189. You just can't beat this price for this type of luxury accommodation. Hurry and make your reservations now before we sell out! I see many of you agree as we are rapidly filling reservations. Don't delay, get your spot now!

I also looked at the list of speakers today, reviewed the workshops, and I tell you, it doesn't get much better than this! Check out these mini sessions and workshops: A PA primer for new PAs, Topics for PAs in administrative roles, Topics for PAs in education, Fracture description from pediatrics to pathologic, fracture fixation (basic and advanced), MSK ultrasound, casting and splinting, graft preparation, wet labs (cadaver practice) hip and knee arthroplasty, bone health, coding and billing, MSK exam (upper and lower extremity). Folks, you won't get this level of education at any other meeting. If you are looking for the knowledge, AND hands-on practice and skills you need to be an effective APP in orthopedics, this is it. I didn't even go over the course syllabus-fracture management, arthroplasty, foot and ankle topics, spine talks, sports med, shoulder, knee, hand and wrist. There will be reimbursement talks, networking, poster presentations of PA research, and more! We will have a variety of most everything! I'm sure some think I am over promoting this, but you really have to go to one of these meetings! I can't help but get excited thinking about it!!

OK, what else is new (other than San Antonio). Well, the LMS is fully functional. Even if you don't need any more CME, please go check it out and let us know what you think. Go to the PAOS home page, login, and click on the CME link in the title bar and follow the learning center. If you need some CME, there are both self assessment exams and AV recordings that you can buy (discounted for PAOS members). If you want to refresh/update your knowledge on various topics, there are over 50 videos (that was my last count, I think more than that now) that are FREE to watch for PAOS members!! These are recordings from prior meetings that are no longer valid for category 1 CME, but are still valuable resources for your knowledge and reference. AND you can count the time spent as category 2. Guys, this member benefit alone is more than worth the cost of PAOS membership! You just can't beat this deal!

I am happy to announce our scholarship committee is working diligently on the applications we received this year. I think we received over 60...I am going to suggest to our BOD and the SLM BOD that we further this effort! Thanks to Krista Bartlett, every PAP in the US has been contacted and is aware of our awards. We also have close to 200 PA student members as a result! Now that is something! As always, we will be raffling an iPad in San Antonio with 100% of proceeds going to the SLM fund. Your generosity helps us maintain this program and helps our future colleagues come along. Thank you all in advance who help to make this happen.

I am working hard to get San Antonio charity clinics to attend our complimentary MSK injection workshop in August. I've written extensively on PAOS CARES, our outreach program-see prior blog posts. I hope we have a successful turnout-if you are interested in doing workshops in your community please contact Elizabeth Darr, Chris Merchant or myself and we will help you put it together.

Steven Kelham and Randy Pape (SE and SC regional directors) did not run for office this year. We wish them farewell and good luck in whatever path life takes them, and we appreciate their service to PAOS. We also welcome Josh Porter who will be taking Steven's place as SE regional director. And since we are in the south central neck of the woods in a couple of months, let us know if you are interested in the SC regional director position. I do not want to leave this position vacant. Come by the registration desk and let us know if you are interested-I think we will have a special election.

Well that's all I've got for now. I hope you can come to San Antonio and join us! It is going to be awesome!

I am typing this as I sit at the registration desk in Charlotte. We have 224 registered attendees, and to a person I have heard nothing but good comments about the lectures and accommodations. Thanks Scott Rheinecker and Elizabeth Darr for putting this together. Also Chris Carrier thanks for creating the event app. A job well done! I am always impressed at the quality of the content and variety of talks at these meetings. It definitely fills a gap. We will have the AV recordings ready in about 6 weeks. These are an excellent resource for you and an easy way to get CME on the go. Please consider it for your educational needs.

I am a broken record; our LMS is still not live! I am very ready for this to happen, but it is beyond my control at this point. I am told that the actual production site is up, but there are still a few bugs being worked out. Any day now....we will send out an eblast to membership once it goes live. When we finally do have this available, you, as members will have an awesome new benefit. All of our prior AV recordings that have expired for category 1 CME will be available in a resource library. This means that as a member, you will enjoy full access to the entire AV library from prior conferences. I cannot believe what a great reference this is and I'm very excited about this benefit! I ask for your patience please, just a little bit longer...

I wrote an on boarding manual and have loaded it on the LMS. It is designed for new hires and/or PAs who are new to orthopedics. I typically precept new hires in my practice and have been told that it is useful in their early days. I hope that you find this to be the case and are able to use it in your practice.

Moving forward to the next big thing-August in San Antonio. There are already close to 100 attendees signed up for our annual meeting! Crazy! We anticipate a fun week of lectures, golf, river walk, tequila tasting, star gazing and of course the lazy river water park! I hope you make plans to come-it is a great destination and is family friendly if you want to have a combined meeting and family vacation. Sign up early and save some $$. And this is really, REALLY cool as we don't offer these often-there will be a wet lab where you can practice on cadavers. You won't get this at many meetings so please come out and take advantage of some great hands on practice.

Thanks again to all involved in making Charlotte an ongoing success! I hope to see you floating down the lazy river at the JW Marriott in San Antonio in a few months!

I am happy to say that thanks to the efforts of Krista Bartlett, we have reached out to every PA school nationwide to inform them of our offerings. As a result, we have the largest number of student members, EVER! We also have OVER 60 applicants for this years SLM scholarships, another record! I am very proud of these accomplishments, and look forward to congratulating the scholarship winners. Good luck to all of you who have entered!

Regarding our LMS: I have to apologize. I feel like I have let you down and I hate this! We were supposed to have this system online and functioning weeks ago, but there has been one issue after another and it is still not ready. I am hoping to roll this out by next month.... For all of the attendees who are awaiting the SA from Arizona, I apologize to you. We want to have this content in the LMS so that we do not have two separate systems to keep track of. I ask for your patience and we will get it to you asap!

Apparently setting up a LMS is not only a problem for us, but the AAPA as well! We have been working with the educational team at the AAPA since last fall to get our Nashville AV online for non PAOS members. Here (click on the word Here) is the link to the Nashville AV in the CME catalog on the AAPA website.This is the first of our offerings in our collaboration with the AAPA. I am hoping this increases our exposure as an organization and gets our quality ortho cme out to a larger audience.

The ballots are now closed for 2019 PAOS BOD elections. Good luck to all of you who submitted an entry for the respective positions available in this years elections.

If you can't make it to Charlotte this year and have room for one meeting, please keep in mind our annual meeting in San Antonio this August. This will not only be a great conference with lots of skills labs on site, but also we are working on a cadaver wet lab! We don't have these often but it is an awesome benefit! Also, the JW Hill Marriott resort and spa is a great destination for families. For you golfers, the PGA tour stops here at one of the two championship level courses on property (The Valero Texas open). Best of all, you can get two things for the price of one; a great conference and a fun family vacation! Nothing like floating down the lazy river in an inner tube with a pinkie droo in your hand! And I didn't even mention the Alamo and the river walk!

I hope you are having a good spring and thanks for your membership! Until next month...

UPDATE!!!

We have learned that the Texas Medical Board will be postponing the adoption of rule 193.21 until at least the late Spring or early Summer.

This rule would have removed the ability for a physician to delegate the reading, interpretation and diagnosis of medical conditions based on radiologic studies- thereby making a significantly negative impact on the practice of PAs across the state.

There will be a stakeholder meeting later this Spring regarding this rule, and you can be assured that TAPA will be present to make sure PA practice is protected.

Thank you to everyone who has contacted the Texas Medical Board about this rule so far! You can continue to contact them at the address they have provided- rules.development@tmb.state.tx.us.

We’ll continue to monitor this situation closely, and will provide more information as it becomes available.

From the Physician Assistants in Orthopaedic Surgery (PAOS) Board of Directors:

It has come to our attention that the Texas Medical Board (TMB) has proposed a rule change regarding Physician Assistant (PA) practice that we believe would be significantly detrimental to PAs in the state of Texas, especially to our orthopaedic colleagues.  As the primary constituent organization for PAs in Orthopaedic Surgery within the American Academy of Physician Assistants (AAPA), representing over  2,000 specialty-practice PAs nationwide, the organization opposes TAC 193.21(d) and supports the Texas Academy of Physician Assistants (TAPA) position on the rule. 

Texas Occupational Code 204 requirements for PA scope of practice are reliant on radiologic procedures to perform diagnosis, develop treatment plans, oversee progression of care, and determine treatment efficacy and endpoints.  These processes are extensively required to practice orthopaedic care and practiced daily by PAs throughout the United States and in Texas.  Patients currently treated for fracture management or palliative joint therapies would be delayed from appropriate care if orthopaedic surgeons were required to supervise at bedside for every reduction or injection. Further, NCCPA-derived PA student curriculum requires initial radiologic didactic and clinical training under physician supervision prior to graduation and certification. AAPA and the American Society of Radiologic Technologists (ASRT) further identify a framework for training in ionizing radiation/fluoroscopy that has been published since 2009. Intentionally broad or vague language contained within Texas Administrative Code for radiologic procedures performed by physician assistants contributes to this continuum of misunderstanding. Texas Occupation Code Section 601.056 regarding Medical Radiologic Technologists incorporates licensed physician assistant authority for performance of radiologic procedures, including those deemed dangerous or hazardous. The key component to updated language is the need to act inherent as a privileged provider that interim evaluation of radiologic imaging provides. Delaying care for the final/formal read by a qualified physician in all cases is not in the best interests of injured patients seen by PAs working in orthopaedic services.  

PAOS is unaware of any evidence that reading or interpreting radiologic studies in the delivery of care by a PA, while working within practice agreement and granted organizational privileges, is harmful to patients.  Across the U.S., PAs in Orthopaedic Surgery rely heavily on ordering and interpreting radiologic modalities to provide comprehensive musculoskeletal healthcare, as well as emergent stabilization of musculoskeletal injuries.  Restricting the ability of PAs to leverage and interpret radiologic modalities may prevent stabilizing treatment of musculoskeletal injuries and could lead to harmful outcomes.  These roles are imperative in rendering life and limb saving measures to musculoskeletal injuries and conditions.      

PAOS stands with TAPA in its request to reject Rule 193.21(d) of the Texas Administrative Code.  Rejecting this code ensures that PAs are able to order and interpret radiologic studies during management of musculoskeletal injuries and conditions.  It furthermore prevents disruption of treatment and prevents potential endangerment of the patients they PAs serve.

Comments and questions for this email may be directed to Benjamin K. Kocher, Vice President, PAOS and can be reached via phone at (443) 910-4489 or by email at bkkocher@gmail.

Sincerely,

 Board of Directors

Physician Assistants in Orthopaedic Surgery, Inc.

PO Box 10781

Glendale, AZ 85318

But those are subjects for another time. The main subject of this post is membership. I am proud to inform you that we have reached a significant milestone and one that I have been looking forward to for some time. We are over 2000 active members strong! I am so happy about this and I want to thank each and every one of you for your loyalty and belief in PAOS and helping to support our mission.

Last fall in Nashville it was my privilege to meet the founder of the PAOS, Joe Lindahl. For those that don't know, our student scholarships are named after his wife, Susan. When I first saw him walking down the registration hall, he had a look of incredulity on his face, checking out all of the displays, reading the research papers, and taking in the size of the audience in the main lecture hall. Later, when I had a chance to meet and talk with him, he kept telling me how incredible it was-the growth of our organization. It is pretty impressive when you think of it. Imagine a handful of orthopedic PAs who wanted to form a dedicated constituent organization so many years ago and comparing it to where we are now.

Anyway, I want to thank you all for supporting us. We couldn't be where we are and doing what we are doing without you!

Our student membership segment is also growing well, and that is an awesome thing! I have to mention one of our BOD here, as she has been working diligently at contacting PA programs across the nation to let them know about us and our scholarships. Krista Bartlett, our SW regional director deserves the credit for this. Thank you Krista. This has been something I have wanted to do since being elected. I want to engage students who are interested in orthopedics before graduation so they know about us and our offerings. This is where the future of our profession/organization lies and is why we need to cultivate a relationship in the early stages. We are working on student BOD positions and should have these going soon.

Other updates:

Conferences: In addition to the member update of 2019 members for 2019 (seriously, that was the count a few minutes ago), we are sold out for Arizona. Way to go everyone involved! Charlotte is also going to be a great meeting - orthopedic trauma  for general orthopedics. Registration for that will open the first of February, so make sure you sign up as we expect it to sell out-that has been the ongoing theme for the last several meetings. We will be in a different hotel than the last couple of years in a more lively area in Charlotte. It will be a great meeting! And I am told that the speaker lineup for San Antonio this fall is already taking shape. Can't wait to revisit the river walk. And the floating river, floating on a tube with a pina colada in hand. And championship level golf courses right outside the hotel...paradise! Plan your trip now and bring the family for a nice vacation-its a great way to get your cme and relax at the same time! Whatever meeting works for your schedule, make your plans now to come get some quality cme that is way more relevant  to your practice than anything else out there. And that is not just blowing smoke, it is the truth! I think that's another reason why our membership is growing so well.

LMS: We are plugging along with this. I am hoping to have it up and running in the next couple of weeks. I know I have been talking about this for awhile, but it is going to be a nice benefit for you once we get it going. Not only will there be a more user friendly way to do your online cme, we are also going to develop a library of 'old' AV recordings. You won't be able to use these for category 1, but they will count as category 2. And only PAOS members will be able to access this. For those who ask "what else do you get for being a member"? How about unlimited access to all of our 'expired' AV recordings for reference and category 2? Now that is another reason to sign up!

Salary survey: The annual practice and salary survey is now online for members. Check it out to see where you compare to colleagues across the nation, your region, or even your state. Thank you to all who participated in this survey, you make it more meaningful to all of us.

I could go on, but that is enough for now. You all take care and stay warm-spring is just around the corner!

Sam Dyer, PA-C, MHS

President PAOS

I am writing this on a snow day which means most everything in my area is closed. It is beautiful! The good news is that I get a free day, the bad news is that when I go back to work I will be crazy busy with all the DRFs, back injuries, and multitude of other trauma associated with slippery conditions. I am enjoying the relative peacefulness right now though. It's sometimes difficult to relax and take a minute to enjoy ourselves given the go go go world we live and practice in. It's good to sit back and take a deep breath and just be for awhile. I hope you and yours are doing well and making plans for holiday time off with family and friends. I wish you all a safe and relaxing holiday season and a prosperous new year!

Quick updates:

There is still room for you at our inaugural February meeting in Phoenix. What a respite from the cold months! Register now to get the best rates!!

We've had a great response to the practice and salary survey-thank you for your efforts. Look for the completed report in the near future.

The building of our learning management system (LMS) is well underway. We hope to go live with this early in the new year, stay tuned.

Nashville AV (PAOS in the Music City) recordings are now available on the PAOS website-look under the CME section. If you need some hours before the end of the year, or can't go to a live meeting, this is a great option. Remember, you only have to watch the videos and complete an evaluation, post tests are no longer required!

I again wish you all a safe and happy holiday season.

For this post, I am copying a write up from our BOD secretary (Karla Frick) on Thanksgiving and what are you thankful for? I hope you take a minute to read it and enjoy the message.

Please don't forget about Arizona in February-we have sold almost half of the seats already!

And make sure to respond to the practice and salary survey when you get the email, it is such an important thing to do for our organization!

I hope you all have a safe holiday and get to spend some quality time with your friends and family!

Here is Karla's write up, enjoy!

What are you Thankful For?

This week we celebrate Thanksgiving and reflect back on what we are thankful for.  Like many of us, we have become so wrapped up in our daily lives that we forget to be thankful.  Patients, supervising physicians, staff, schedulers, spouses/partners, kids, extended family and friends all seem to occupy our daily thoughts and focus. It’s often not easy to remember to take time and be thankful for all that we have and all that we are.  But I’m positive that if we all don’t slow down and stop to just simply give thanks, that time will continue to fly by and at the end, we will have missed our chance to enjoy the simple things and be thankful for it all. 

I challenge each and every one of you to sit down for just a couple minutes this week and be sure to thank all of those who impact every part of your life.  Thank your significant others for being patient when your days run long.  Thank your patients for trusting in you.  Thank your staff for putting up with you, especially on those days when nothing goes right.  Thank your kids for making you smile and laugh. Thank your surrounding family and friends for always supporting you.  Take time to even thank someone you don’t even know.  But mostly take time to be thankful of yourself.

It is a known quality that most physician assistants are selfless.  That we try to please everyone else first.  We make sure that our physicians are always happy, that our patients are treated well and with respect, that our staff is helped and supported, that when something goes wrong, we are the first to take blame (after anesthesia of course)!  It becomes exhausting after a while.  So, please, remember that you are worth being thanked.  That your sacrifice to help others is not forgotten and that you should be proud and thankful for all that you are.  

Here are some quotes that may help you reflect on this time of year.

"Let us be grateful to people who make us happy; they are the charming gardeners who make our souls blossom."--Marcel Proust

"I may not be where I want to be but I'm thankful for not being where I used to be." -Habeeb Akande

"As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them." -John F. Kennedy

"Acknowledging the good that you already have in your life is the foundation for all abundance." -Eckhart Tolle

"If you want to turn your life around, try thankfulness. It will change your life mightily." -Gerald Good

"Make it a habit to tell people thank you. To express your appreciation, sincerely and without the expectation of anything in return. Truly appreciate those around you, and you'll soon find many others around you. Truly appreciate life, and you'll find that you have more of it." -Ralph Marston

"But Thanksgiving is more than eating, Chuck. You heard what Linus was saying out there. Those pilgrims were thankful for what had happened to them, and we should be thankful, too. We should just be thankful for being together. I think that's what they mean by Thanksgiving, Charlie Brown." - Marcy

And I want to give thanks for our organization (PAOS) and their dedication to try to constantly improve our profession.  Their desire to reach out to the community and give back through CARES.  Their desire to give back to the profession with the Susan Lindahl Scholarship.  To our members who advocate for all other PAs in our profession.  To all my co-workers and board members who are dedicated to make our organization successful.  But mostly I want to give thanks for those who have served before me and paved the way for all physician assistants.  I am blessed to work in a profession that I love and I am so excited for all that is to come in the New Year. 

I hope that you truly have a blessed Thanksgiving week and holiday season and that you are able to reflect on what you are thankful for. 

Please feel free to post what you are thankful for.  We would love to hear your stories!!

Karla Frick, MPAS, PA-C

Secretary

We have started our 2018 practice and salary survey. PLEASE respond to this and take some time to complete the survey. It is such an important member benefit and the more responses we have the more accurate it represents us in our orthopedic practice. You can take this survey and use it as a bargaining tool for your position, benefits, salary, etc. Please help us with this. It is one of the most important things you can do for your profession and colleagues.

So we are in the initial stages of developing a learning management system (LMS) for PAOS. I am very excited about this (I'm always excited about PAOS activities). With the LMS, we can better distribute cme content and develop new and different ways for you to get your continuing education. We are hoping to have this up and running by the end of the year; stay tuned.

I am also getting more responses about PAOS C.A.R.E.S. If you haven't read about it, it is in a previous blog. I hope you consider helping us out with this advocacy program and truly make a difference.

Don't forget about Arizona! We have already sold over a third of the seats-this is going to sell out, soon!! Please don't procrastinate on this, sign up now! It is going to be beautiful in Phoenix in February.

Please consider getting involved in the forum discussions. We are posting weekly topics here and our BOD would be happy to moderate discussions. We would love to hear your thoughts on current practice patterns, how you treat conditions listed in the forum, tips and pearls. Its all about sharing your knowledge with others to hopefully help make us all better providers.

That's about all I've got for now.

Happy fall!

And finally, by popular demand, we have opened registration for our first annual west coast meeting in Phoenix in February 2019. Details for the meeting are on the main webpage. We have already booked almost 20% of the spots, so if you want to go to this meeting, you need to register NOW! I expect this meeting to sell out quickly, so please do not delay. Word of mouth spreads quickly! As I have said in previous blogs, our membership is growing rapidly. One of the main reasons for our rapid growth is that we offer quality cme geared toward advanced practice providers (APP's) in orthopedics. We are not trying to educate residents in ortho (AAOS). We are not trying to educate primary care providers in basic orthopedics (MSK Galaxy). Our goal is to provide quality continuing education to practicing APPs that you can use in your daily practice. If Arizona in February doesn't work for you, we will have two more opportunities in 2019: Charlotte in May and San Antonio in late August. And don't despair if the timing doesn't work. Each meeting will be recorded and the AV of each speaker and their slides will be offered for your online education. I am so happy to bring you all of these opportunities for quality education and I hope to see you at one of the meetings!

Disclaimer: If you do not register before the course is sold out, we cannot guarantee you a seat. This means unless you have paid your registration fee and have been given a seat at (any of) the meeting(s), you will not be recognized as attending the meeting and will not be granted cme. Further, we are not responsible if you book your travel/lodging without first making sure you are registered for the meeting. YOU NEED TO REGISTER TODAY AND GET YOUR SEAT BEFORE YOU BOOK YOUR TRAVEL!!! I am not making this up. We are selling out of our meetings and when the spots are sold, that is it. We can't squeeze you in (the fire marshals only allow us so many attendees). You must be proactive and book your spot asap! Please don't delay. You won't regret going to our conferences!

Thanks all and thanks again to those who have recently renewed!

PAOS has been around for a long time, and over the years we have had many members who for whatever reason let their membership lapse. I think some have changed professions, some have looked for other content providers, but many (I think) just forgot that their membership expired. Life happens. Work happens. Family happens. Many things take center stage and membership in PAOS is the last thing to think about until its time to get CME. I understand this very well. We have thousands of former members-and I think many have just forgotten to renew their membership. To those folks I want to make it easier for you. We have simplified the membership categories-this was long overdue and I apologize for not addressing it sooner. We now offer auto renewal so you don't have to remember if you need to renew-we'll do it for you. For those that want a variety of educational topics, I believe that we now have the resources and cme content to provide you with all your cme and conference needs. For those that are no longer members, I want you to come back to us. There is value in a PAOS membership ranging from discounts on quality conferences, books and audiovisual content, to an exclusive national practice and salary survey that focuses on PAs in orthopedics. The survey alone is worth more than twice what PAOS charges for membership. There are so many things that are available to you as a member, I hope you consider joining us.

We will soon be initiating a membership drive focused on former members. I hope that this will bring more members back and allow us to continue to grow, both as an organization and a community of orthopedic professionals.

So I wanted to recognize and thank Jason Mckown from Colorado. He recently did an injection workshop for PCPs in rural Nebraska using PAOS injection models and literature. He also taught several Army medics some basic injection techniques-attached are a few photos.

I have a plan to do another workshop in my area next month, I hope you consider being an ambassador for the PAOS and doing a workshop in your area. Just let us know if you're interested and we will get you the information you need.

On a different note, Labor Day week in Nashville is only a couple of months from now. I hope you all pack your cowboy shoes, hats, and sign up for our meeting and fun! We are all excited about this one and we have some excellent speakers lined up for you too! Make sure to take advantage of early bird rates. If you can't make it, please consider another conference next year - we'll have plenty. And don't forget about our AV material if you can't go but want to learn from home.

Thank you all for your support. Without our members, none of this would be possible. Please tell your colleagues and business managers about us. Like us on facebook and follow us on twitter. Use our career center if your looking to make a change. Use our practice and salary survey if you are negotiating your contract. We are now doing routine posts on the forums, please consider getting into the mix with your thoughts and comments.

That's all I've got for now, take care ya'll!

So last year I volunteered in a local community health center (CHC) trying to mentor the primary care providers in musculoskeletal exams and injection techniques. The ultimate goal was to improve under served patient access to orthopedic care-referrals to orthopedics sometimes take 2-3 months for something as simple as getting a knee injection. While I was told that my efforts were helpful, I felt that I did not reach as many providers as I wanted due to scheduling issues and lack of a dedicated orthopedic clinic. What I found was that the most beneficial service that I could offer was to teach common injection techniques to the providers. I subsequently decided to offer a free injection workshop for those that wanted to do more.

I (PAOS) purchased six injection models for training. I also authored and designed an injection booklet (sample excerpt below) complete with pictures and tips on injections (pics below). I then hosted (at my practice) a Saturday morning workshop where I had nine of the CHC providers (MDs, PAs and NPs) attend. It took about 2 hours, and I am told by the CHC medical director that it increased their knowledge and skill and many are now offering injections to their patients. I also created a certificate of completion so that they can have proof for their credentialing authority. I have also been in contact with another large CHC in my state and we are working on setting up future workshops.

This lead me to think why not offer this on a national level? The PAOS has routinely donated money to local charities at our annual conferences as an advocacy effort, but I would like to expand our outreach by being advocates for communities. I want to engage our members to be PAOS ambassadors and offer injection workshops for community health clinics and rural health facilities in their communities. So I introduced the idea to the attendees at our Charlotte meeting and had several people interested. In fact, we have a tentative workshop planned for a rural community in Nebraska. I also plan to introduce this at our annual meeting in September where I hope it gains some traction. I even have a name in mind; PAOS C.A.R.E.S. (Community Advocacy and Resources for Educational Service). If any of you who read this are interested in hosting your own workshop, we (PAOS) will provide training materials and reimburse some of your expenses. Just let us know.

This discussion provides a segue into another issue. I would like to talk about retirement issues at some point. There are many of us who have more working years behind us than in front, and I think it a worthwhile topic to discuss. Do any of you have any thoughts on the matter? I think I will start a forum on it. What topics would you like to discuss? I think financing retirement, long term care insurance, social security and others are all relevant issues. What do you think?

On a more personal level, my state legislature is rolling out legislation regulating the prescription of opiods. The highlights of the legislation include limits on prescription quantity (5 days for acute pain and 7 days for post op), mandatory search of the patient's previous 12 month prescription profile on the state website by prescriber or delegate prior to prescribing opiates (also mandatory reporting of the prescriptions by pharmacies to the state with potential for audits of both prescriber and pharmacies-legal ramifications if non compliant), documented PA/NP consulting with MD if pain clinic role on prescriptions for > 30 days, and eventual mandatory E-prescribing of all scheduled substances. My state also requires that at least two hours of category 1 CME per cycle be in opiate prescription practices.

How is your state responding to the 'opiod epidemic'? Do you feel that increased regulation is a necessary way to control the problem or is it creating a further burden on your ability to practice (or both)? Many states offer free prescription cme through their medical boards; the PAOS will continue to offer it as part of our conferences to help you with this requirement. I would advise you to check with your state medical board for updates as this will probably affect us all at some point.

As our way of saying thank you, please check out the free video on our main page that you can use for category 2 cme, compliments of the PAOS. Thank you for all you do!

I hope you have a great day/week!

I'm taking a day off from my clinic job to catch up on emails and other tasks. I hope you all had safe travels and are back with family and friends. My thoughts and prayers to our colleagues in Texas; I hope that you all weren't affected by Harvey and if you were, I wish you a speedy return to normal.

PAOS sent all attendees a post conference survey, please complete it so we can have more information on how to improve our future meetings.

What did you like best about the meeting? I was quite impressed by the first ever poster presentations. Kudos to all of you who entered a project! Well done! I hope that we can expand this effort next year. We are also planning on student papers/presentations linked to the scholarships. If you know of a deserving student, please direct them to our scholarship page.

Also please utilize the forum section we have created. i would like to increase our member engagement.

Thanks to you all who made Baltimore a success.

Sam

Is anyone as excited about Baltimore as I am? Our committee has planned an exceptional event with instructional workshops, an awesome lineup of lectures, and fun social events. I can't wait to check out the inner harbor, Camden Yards, get some seafood, and enjoy myself for the week. I hope to see you all there.

CHEERS!!