Chapter 1

Driving back from a meeting at the University hospital this late Saturday morning, Physician’s Assistant Joel Parker thought about what had happened since he had graduated two months ago from the PA program. Prior to graduation he had interviewed with the Wilkinsing foundation Representative and committed to working for them for six years at a location they would select. In return for his commitment they would pay off all of Joel’s student loans and compensate him with a competitive salary. He had thought in entering the PA program initially that he would be working for a Doctor at his practice but that did not happen. He was assigned to be a PA at the towns of North Rivers and Portello, California. He communicated with Doctors through the use of an improved version of Skype who supervised and oversaw Joel’s treatment of patients.

To say that functioning as a PA in these small towns was a challenge would be an understatement. Besides doing what a PA does as to the patients he examines there were some extensive managerial problems that he had needed to address and solve.

While driving to North Rivers Joel saw that he was entering the town of Lake Lancer and thought he would stop by the clinic to say hello and see if there were any problems. Joel had referred a number of his patients to this clinic for blood tests, x-rays, and cat scans.

Walking into the clinic he could see the waiting room was empty and it looked like they were ready to close for the day. Doctor Steve Brandle was getting ready to leave and in seeing Joel said hello.

“What brings you here today?”

“I was just coming back from a meeting we had at the hospital and thought I would stop by and see how things are going.”

“Things are going fine here, how about you?”

“We are getting there and it has been interesting.”

“Why don’t we grab a bite to eat at the diner down the street and you can tell me all about it.”

At the diner after placing their orders Joel said, “I understand that this program of PA’s being in these medically underserved areas was your idea.”

“Yes that’s right, it seemed like something that should be done.”

“Well you do understand that putting a PA in these towns just doesn’t instantly solve a problem. There is more to solving that problem that needs to be done.”

“Please explain.”

“The main reason this program can work is because of the use of the computer and the Skype improvement program for the PA to be supervised by a Doctor. This program heavily relies on the use of the computer and a PA needs help on doing the computer input on new patients and keeping the computer current on prior patients. If the PA spends his time doing all this required computer input the time he has to spend with the patients becomes limited and detracts from his duties. He becomes an input computer operator rather than a PA. It is mandatory however that this input be done because that is how we order tests, see test results, keep the patient’s profile current and for home base to do the billing.”

“I immediately saw this as a major problem and discussed it with the Mayors of the two towns I was assigned. They suggested I attend a PTA meeting and bring this problem to their attention. This was a good suggestion on the Mayors’ part since I will somewhere along the line probably have those PTA members and their children as patients.”

“I attended a meeting and received an excellent response. A number of the mothers offered to volunteer their time to solve this problem. One will work as a receptionist and input the information from the paperwork the patient completes while another mother will work as a nurse in putting the patients in interview rooms and doing the prep work of blood pressure, temperature, oxygen level as well as checking that the list of meds if any the patient is currently taking is correct. We have one mother who works during the day at school but she handles from her home the rotational staffing of which mothers will be working what days at my location.”

“It didn’t take that much of my time to do their training and it has been well worth the effort in doing it. Oh yes, I may add that because of the software that has been provided it is not a first come first serve operation at my locations. We do appointments for the two days a week I am in both towns starting at nine and ending at two. After that we will handle any walk-ins if there are any.”

“It sounds to me that you have been a busy boy.”

“I have been that but I will say the town has rolled out the red carpet for having a PA there. Some of the men have also helped out by fixing up our building. They built a reception area along with interview rooms. They even made the building more secure since we do keep some expensive and sensitive items there.”

“How about the treating of your patients? How is that going?”

“I would estimate that I and my Skype overseer can take care of fifty to sixty percent of the patients we see with no further treatment necessary mainly by giving some advice or writing some prescriptions. The remaining patients require some further action as blood tests, EKG’s, x-rays, or CAT scans and maybe some other testing. The computer software lets me order up these tests and the results will be posted on it. I will say the software put together by the Wilkinsing team is state of the art and real time saver.”

“I will also say that the hospital administrator Karl Bridges must enjoy the favorable publicity this program has received nationwide since it looks like he is trying to make it a model program. To that end he announced at the meeting today that he had for us PA’s of which there are now five of us with three more to come, some additional refinements to this program. He is contracting with Northern California Mobile Medical Health Services Company that they will stop by each PA location once a week at a fixed day and time which is TBD to draw the blood from the patients for the tests we have ordered. That makes it more convenient for the patients with this service doing that.”

“Karl also said that he has been in contact with the Medical Board about the hospital giving some of our volunteers training on where and how to attach the electrodes so that they can do an EKG. The kicker is that they will by supervised by a certified technician who is watching them doing this by Skype. The completed EKG will be sent via the internet to a cardiologist for a reading. Karl said the Board will probably approve us doing this.”

“One last thing, the tests we give and the results as you know are all posted to the patient’s computer record. Besides me seeing the results they are all reviewed by the Doctors supervising me. They may or may not may any comments as to the test results. When I start to work at eight I will review the test results that are recently posted and the Doctor’s comments if any. I will either send the patient an e-mail or have a volunteer call the patient with the results. If necessary I may ask that the patient come in to see me for a discussion. There have been some patients that I have told they need to see a cardiologist or maybe other specialists. Overall I have a good feeling about what I am doing, knock on wood.”

“Enough about work how is your social life?’

“It could be better. There is Ken’s which is a local watering hole that has a live band, small restaurant and a large bar area and attracts a good crowd on Saturdays. It is quite a pleasant change to see the women who usually wear jeans during the week spruce up and put on dresses when they go there. I will say some of them clean up quite well. If I do go there I limit myself to two beers as they don’t need to see their PA get drunk and make a fool of himself. Besides going there one of my patients is teaching me how to fly fish which I fine to be quite interesting. There is also a nine hole golf course there which isn’t the greatest but I will on a Sunday play eighteen.”

“Do you have a golf handicap?”

“Yes it is my putting... , I am kidding but I am probably up to a ten now since I don’t play that much. In my prime I was down to a seven.”

“I’ll keep that in mind and maybe you can join me for a round at my club. The golf course is rated in the top one hundred in the nation.”

“That would be great but enough about me already, tell me what is going on with you.”

“I don’t know if you know but Valerie my wife is now the head of the separate division of the Wilkinsing foundation handling this PA and Doctor program for these medically underserved areas. The program is now expanding from California going up the coast and will be going into the mid-west. John Wilkinsing gave some additional funds to do this and along with some donations from other interested people and agencies. There is a base of just over four billion dollars and the funds it generates foots the bills for this endeavor.”

“You may have noticed the construction going on at the unused school building coming into town which is going to be the headquarters for this program. Right now Val is heavily involved in hiring people to staff the operation. That operation is going to be a shot in the arm for the economy of Lake Lancer. One builder is building a condominium building across the road from the lake for the anticipated housing needs of these new employees. As some of the people here say, “These are exciting times in Lake Lancer.”

Seeing that the time had flown by Steve and Joel left the diner and walked back to the clinic where their cars were parked.

On the walk back Joel said, “I don’t know if you know but Karl at the meeting today mention that the Wilkinsing foundation has given the hospital a grant to startup and have an air ambulance service. He gave us the guidelines on when we can call for it.”

Steve said, “One time John Wilkinsing told me he would give me a helicopter for the clinic here to use but I told him that was overkill.” Steve laughed in remembering that conversation.

On the drive back to his apartment in North Rivers Joel knew he had time to shower and shave for his date tonight which he expected to be very enjoyable.

In doing this drive Joel thought about how his upcoming date tonight came about. At the PTA meeting for North Rivers Joel couldn’t help but give a good look to the women that were there. There were some very good looking women in Joel’s opinion which he thought was the good news. The bad news he thought was that the reason they were there was because they had children in school and were all probably married.