Meet the Board: Amanda Michaud, DMSc, PA-C, AE-C

Key takeaways:

• The role of physician assistants and advanced practice providers in allergy and asthma is growing.
• Prior authorizations, step therapy requirements and nonmedical therapy switching remain issues.

As asthma and allergic diseases grow in prevalence, clinical practice must adapt to meet these changes. Physician assistants are helping to meet the growing patient demand by working collaboratively with their physician colleagues.

“In general, with allergic diseases on the rise and more and more patients seeking care from allergists, there has been much more involvement of PAs or other APPs [advanced practice providers] in patient care,” Amanda Michaud, DMSc, PA-C, AE-C, the newest member of Healio’s Allergy/Asthma Peer Perspective Board, told Healio.

“It seems there are a lot more APPs in our specialty than when I began in this field over a decade ago,” Michaud, who also is a physician assistant at Family Allergy and Asthma Consultants in Jacksonville, Florida, and secretary of the Association of PAs in Allergy, Asthma & Immunology (APA-AAI), continued.

Additionally, Michaud holds committee appointments with the American College of Allergy, Asthma & Immunology and the American Academy of Allergy, Asthma & Immunology, where she has served as the APA-AAI liasion, and has published in peer-reviewed journals and spoken at conferences.

“I think this part of my career is especially important as it helps advance the PA profession and provide us a welcomed seat at the table, so to speak, as valuable members of the health care team and contributing to educating and teaching others,” Michaud said.

“Seeing PAs in these roles may enable or inspire other APPs to become involved in educating or serving in leadership positions as well,” she continued.

We spoke with Michaud to find out more about her practice and her views of today’s allergy and asthma care.

Healio: How did you come to pursue allergy/asthma as your specialty?

Michaud: As a new PA, I first started out in emergency medicine/trauma. Although I loved the fast-paced environment and procedures, I felt quite a bit of burnout. When my family was moving across the country, I took this as an opportunity to try something new. I found an opening at a busy, highly respected allergy clinic, and it seemed like a good fit.

Besides growing up with a peanut allergy, I had very limited knowledge about the allergy/immunology specialty. Similar to what I heard about med school, we have very little allergy education in PA school. On the job, I was trained by three board-certified allergists who guided me along the immense learning curve and practiced evidence-based medicine, and I loved every bit of it. I found myself enjoying the new advances and development in the field, as well as the ability to treat chronic disease and improve the quality of life of our patients and their families.

Healio: Do you have a particular area of allergy/asthma that you enjoy the most?

Michaud: The thing I love the most about our specialty is that we treat diseases that can impact every organ in the body. We treat chronic diseases that affect the airway, skin, gastrointestinal tract and other organs. I think that is pretty special. Overall, I think I enjoy food allergy and atopic dermatitis the most.

Healio: What challenges do you face regularly in practice that keep you up at night?

Michaud: I’m sure this is similar for most specialties, but prior authorizations, step therapy requirements and nonmedical switching of therapies absolutely impact our practice in a very negative way. It can be extremely frustrating to have a back and forth with insurance companies, all while the patient may be suffering. In more recent years, I’ve also struggled with misinformation and disinformation widely circulated, specifically regarding the use of unproven diagnostic tests for food allergy.

Healio: What do you like to do outside of clinical practice?

Michaud: I played college ice hockey, and outside of clinical practice, I’m very involved in coaching youth ice hockey. I’m currently coaching three teams and travel all over the state to tournaments and games. My husband and brother are both in professional hockey, so it’s a huge part of our life! I also enjoy traveling, spending time outdoors, and taking our two amazing dogs wherever I can.

Healio: What would you say has been the most exciting development in allergy/asthma treatment over the past decade?

Michaud: The development of biologics to treat chronic conditions like severe asthma and atopic dermatitis have been some of the most exciting developments for our practice. The research on early introduction of allergenic foods has also been super exciting and really changed how we practice.

Healio: What advances are you most looking forward to over the next 10 years?

Michaud: I am excited to have more options for management of food allergy, including development of biologics, other medications or immunotherapy options. Although treatment over avoidance is not the right choice for every patient or family, I think it is amazing to have treatment options. I am also quite excited for more therapies that are under development for anaphylaxis, eosinophilic esophagitis and atopic dermatitis.

Healio: How will the role of the PA evolve over the next 10 years?

Michaud: I think there is a huge void to fill for patient access, and we will continue to see an increase in using PAs or other APPs in our specialty. While there is concern from some physician organizations regarding potentially unsupervised independent practice of APPs, in reality, most of us work collaboratively with our physician colleagues or supervising physicians and will gain more autonomy as we gain experience. Personally, my role has changed in the sense that I have fostered a sense of trust among the physicians in my practice, and I get to practice quite autonomously.

For more information:

Amanda Michaud, DMSc, PA-C, AE-C, can be reached at amandamichaud@gmail.com.