Overcoming obstacles in training positions allergy PAs as valuable team members

Key takeaways:

• Amanda Michaud, DMSc, PA-C, AE-C advises new PAs to use training resources and be aware of their self-worth.
• Supervising physicians should support their PAs and encourage them to attend meetings, Michaud said.

As the patient demand for health care grows, so does the need for more physician assistants in medicine. However, a lack of formal training in allergy, limited resources, patient bias and improper utilization can hinder this effort.

“I get approached frequently by allergists looking for information on how to incorporate a physician assistant or nurse practitioner,” Amanda Michaud, DMSc, PA-C, AE-C, told Healio. “I am commonly asked, ‘How do I bring them on?’ and ‘What are some resources for them?’”

Michaud has been a physician assistant (PA) in allergy/asthma for a decade, currently working at Family Allergy & Asthma Consultants (FAAC) in Jacksonville, Florida. She also is CME chair of the Association of PAs in Allergy, Asthma & Immunology (APA-AAI), in addition to holding committee appointments with the American College of Allergy, Asthma & Immunology and the American Academy of Allergy, Asthma & Immunology.

The employment of PAs is anticipated to grow 28% from 2023 to 2033, according to U.S. Bureau of Labor Statistics. Considering this, future PAs and supervising physicians should be aware of the obstacles that PAs, specifically those in allergy, may encounter on their career path.

Healio spoke with Michaud concerning allergy PA training and implementation and how PAs and clinicians can work together to overcome these barriers.

Obstacles in training lead to improper utilization

Training aspiring allergy/immunology PAs presents unique obstacles that may lead to their improper utilization in the field.

Most PA training programs follow a general or family medicine model, according to Michaud.

“There are some programs that are more specific, geared toward surgery or emergency medicine, but most programs have a family medicine focus. Depending on the program, PA students complete six to 12 clinical rotations in fields of family medicine, pediatrics, surgery, emergency medicine or OB/GYN, often with the option for elective rotations. Then, upon graduation, we can pursue PA-specific fellowship programs to get more education, but these are very limited and quite competitive,” Michaud, who also is a member of Healio’s Allergy/Asthma Peer Perspective Board, said in an interview.

However, pursuing a PA post-graduate fellowship is not an option for aspiring PA allergists, as there are currently no post-graduate training programs for allergy PAs, Michaud said. Her initial interests were in emergency medicine after graduating from Midwestern University-Glendale’s PA program. However, when she decided to change career paths and move into allergy and immunology, she received her allergy-specific training on the job at the first practice where she was employed.

“The post-graduate training and education aspect is where I think our biggest need is, because new PAs in the field lack the knowledge to care for the conditions we treat or are underutilized in some practice settings,” Michaud told Healio.

After graduation from an accredited program, there is no strict set of national guidelines standards similar to national board certification for physicians, Michaud said. As a result, post-graduate PA “on-the-job” training is “all over the map” and currently based on a combination of mentorship and guidance from supervising physician, senior PAs or self-directed learning, she added.

This can lead to the improper utilization or underutilization of PAs in a practice setting, she said, because without clear rules outlining what new allergy PAs should learn, their role can become unclear.

Thus, how PAs are utilized and trained and their responsibilities are decided at the “practice level,” Michaud said, meaning that practicing as a PA may be an entirely different experience from practice to practice.

How PAs are utilized will also significantly depend on their experience in the field, Michaud added.

“Naturally, it is common for early-career PAs to have much more oversight and guidance in patient care, whereas more seasoned PAs will generally have more autonomy,” she said.

For example, Michaud practices relatively autonomously at her current practice. However, many PAs also feel that they may be able to do more for their practice or patients, but they may be restricted and therefore underutilized, according to Michaud.

Dealing with patient bias

PAs also face patient bias, which can limit their ability to function successfully within the practice, according to Michaud.

Michaud said she still encounters such bias on a regular basis, “even after over a decade in practice.”

One strategy for combating this prejudice involves bonding with patients who may feel some doubts, according to Michaud.

“I think the way you overcome that is building that trust and rapport and establishing a very good relationship with that patient,” she said.

“Ultimately, we are not fellowship or residency trained, and although we could have tons of experience and feel confident handling any patient who walks in the door, it’s also important to establish with patients that you are part of a team and have support of your supervising physician colleagues,” Michaud added.

There should be a balance between being confident in your own education, training and abilities and being able to identify when a case is complex and may need additional input from an allergist on the team, according to Michaud.

“I try to make them aware, ‘Hey, I’ve seen this before. This is something I’m very comfortable treating,’” she said. “If it is one of those cases that’s quite complex, I’ll have no problem telling them, ‘I’m going to run this by one of the physicians I work with and I’ll give you a call back if they have any changes to our plan.’ It gives them comfort that I’m willing to work with others and get help or reassurance when it’s needed.”

Further, physicians can help to support PAs by supporting their actions and decisions, so long as they are in accordance with what’s best for the patient and follow evidence-based care, Michaud said.

“Often, we share patients in practice and it can be very affirming when a patient receives feedback from a physician at a subsequent visit that they agree with the diagnosis and management performed by a PA previously,” she said. “It helps enhance trust in the PA and the practice as a whole and support the patient relationship.””

Resources for PAs, supervising physicians

To overcome these challenges, resources exist for new PAs and their supervising physicians alike.

Michaud recommends that PAs looking to improve upon their allergy training use available resources, including online conference presentations and CME articles and modules (see Table). She advises becoming a member of the AAAAI and ACAAI, which offers a variety of online resources, and attending PA-geared meetings, such as the annual APA-AAI meeting.

Further, new or established PAs can email info@aapaaai.org with any additional questions concerning being a PA in allergy.

Resources also exist for those physicians supervising or training new PAs.

“If there are allergists reading this piece who want to have insight on how to incorporate PAs and nurse practitioners into their practice, APA-AAI is a really good resource,” Michaud said.

Further, Michaud recommends that allergy physicians first teach new PAs the “bread and butter of the practice.”

“[Focus on] rhinitis, asthma, food allergies, chronic hives and atopic dermatitis and then you can expand upon those topics to encompass everything else we cover,” she said. “Then we get into more specialized or advanced topics like oral challenges and biologics and how to determine who’s a good candidate for those or which agents to utilize.”

Supervising physicians should also encourage their PAs to attend conferences and meetings, which can help them to grow professionally, Michaud said.

The value of PAs

PAs can be a huge resource for allergy practitioners, giving physicians more flexibility with their schedule and the ability to delegate certain tasks to other staff, lightening their workload, according to Michaud.

Having such an adaptable training approach allows PAs in allergy to “really hit the ground running and be very malleable to what your practice needs are,” Michaud added.

However, only when PAs are utilized correctly and supported within a practice can they fulfill those needs, she said.

To her fellow PAs, Michaud emphasizes the important of knowing your worth and recognizing that you are qualified for your position.

“You’re a valuable member of that team,” she said.

References:

• How to use NPs and PAs in allergy practice. https://college.acaai.org/how-to-use-nps-and-pas-in-allergy-practice/. Published Sept. 18, 2023. Accessed Sept. 9, 2024.
• U.S. Bureau of Labor Statistics. Physician Assistants. https://www.bls.gov/ooh/healthcare/physician-assistants.htm#:~:text=in%20May%202023.-,Job%20Outlook,on%20average%2C%20over%20the%20decade. Accessed Sept. 30, 2024.

For more information:

Amanda Michaud, DMSc, PA-C, AE-C, can be reached at amandalmichaud@gmail.com; X: @theallergypac.