Karen Mulitalo Virtual Interview

Hey everyone, it's Mindy Bateman again, director with Crossroads Utah. A heck, and I'm here with Emily Huffman from, um, the Rural House Scholars program. And are you at Dixie or SUU? I can't remember.

I'm at SUU. I see you. Okay, see you in Cedar City. And then we're here with Karen, and I'm gonna, I always say your name wrong, I'm sorry. Mulattalo? That's it, right? That's correct. Perfect.

So, um, Karen, we'll just turn the time over to you for a minute. If you want to take a minute and introduce yourself, your name, where you're from, and where you attended school.

Okay, great. Thanks. Um, my name is Karen Mullethallow. I was born and raised in Bountiful, Utah. I did my undergraduate at the University of Utah in biology, and then I went on to PA school and, um, at the University of Utah. And I graduated in 1996 from PA school there. I have worked as a PA both clinically and academically. Clinically, I've mostly worked with underserved populations, and academically, I've worked at different programs in the country and had some experiences overseas. And now I'm back in Utah, Utah Valley University. Great. I didn't realize you've gone overseas for a bit. So I did for a spell. It was nice.

So, um, what made you decide to become a PA?

Well, I was, um, at the, at this time in the PA profession history, it wasn't quite as, people weren't quite as aware of the profession as they are today because even something like this probably wouldn't have taken place for a class. But I had a colleague. I was in under, uh, undergraduate in pre-med, and I had a colleague come and tell me that he went to St. Louis to PA school, and that it was a great way that they could prescribe and do physical exams and make decisions about patients under the supervision of a doctor. And the amount of time that that took was an interesting amount of time at that, at that time. It was the University of Utah program was just two years. And so I went up and investigated that, um, and I really liked what I heard. It resonated with what I wanted to do and, um, decided at that point that, um, that's how I could be best of use, use my skills.

Okay, that's great. And for those of you that don't know, like you said, it's a career that I think is starting to become more known. Um, but for people who are may still be exploring, can you tell us the difference of PAs versus other healthcare professionals and what they do?

Sure. Um, so if you are, lots of you have probably been seen, if you don't quite aren't familiar with the role of a PA, is many of you have probably been seen by a PA when you go into clinic or when you go to get health services and just not realize that because on the ground as a patient, it may look a lot like services you either get from a nurse practitioner or from a physician. And the, the premise of the profession came about in the 1960s when you had Vietnam War vets with a lot of good field experience and no way to civilianize those skills. So the idea was that they were to take those skills and extend the services of the physician. Um, and so back in that time, the training of a physician assistant was very much on the medical model, meaning the MD model, to help extend services. And they, they got it down for, it was a, maybe a year at the beginning, and now it's over two years. But the other role that's a little bit similar to physician assistant is nurse practitioner. Um, and they build on the skills and the experience of people getting this when they are nurses. So it's kind of the same concept of building on a knowledge base and skills that was with the premise. But PAs can, in most states, diagnose, prescribe, um, do physical exams, order, diet, interpret diagnostic tests. Um, and we're kind of in an interesting phase where in some states they do that independently, in some states it's still under the supervising physician. But the training is, I'm in the scope of family practice, meaning it's going to be a very broad-based, broad brush of medicine that you then specialize afterwards. So you go get a job in a specialty or do an extra little bit extra training and get that specialty. But, um, that is the difference between, uh, those three roles.

So I think something as a student for, like, considering becoming a PA, I think something that's a little confusing is how PA school is structured. So would you take some time to go over, like, the first year PA school looks like, what the second year PA school looks like, and maybe the beginning, like, what happens right when you're out of PA school?

Yep. Sure. So I think, um, as I had explained before, originally it was designed to be a second career training. So in that two years, it's not that now. So a lot of people that go to PA school are what traditionally were medical school applicants. That's kind of how they look now. And we compact a lot of organ system, what they used to call organ system review, or the anatomy, clinical medicine, pathophysiology, and physiology of all the organ systems of medicine from a primary care perspective in that first year. And I think that first year PA school is one of the most intense in any health professions training because that is a lot of information to squeeze into a year. Um, the other thing that happens is when we send, so the second year is clinical year. And in clinical year, you're out doing rotations that are generally, anyone for four to six weeks. The core rotations are family medicine, internal medicine, behavioral medicine, emergency, internal medicine, and surgery, women's health, and pediatrics. Those are the core rotations that PA students get in about four to six week blocks. So you're basically just out seeing as much as you can and getting as much experience as you can doing exactly those things that we said at the end, which is to diagnose, uh, prescribe medication, order diagnostic tests, and do physical exams, takes history, and all those kinds of things. Um, so it is a compact, intense two years because the expectation about where PAs function when they graduate is actually quite high. So when you graduate, you find an employer who hopefully will have an onboarding period for you, meaning they will assign someone to a physician to be your mentor, or a physician assistant to be your mentor for a period of time that they think for the specialty that you have chosen is an appropriate amount of time before you can begin to work more independently. So there's also, um, additional training or the way they call postgraduate training in almost all of the specialties. So if I wanted to, to specialize in pulmonary medicine, I'd graduate from PA school and then I would go to, uh, what's called a residency in pulmonary medicine, maybe for six months or a year. Or I may not get paid as much as you would anticipate I'd be making eventually, but I'm using that time to train in the specialty of my choice. So really, if you look at PA training, you can still do the training and then go get a pretty good job in some of the more general specialties like primary care, and urgent care, and emergency medicine. Even you can probably get jobs right out of school. But some of those other specialties, you probably want to go get additional training.

Okay, that's a great overview. And, and so a little bit off script here, but if, with that intense program, what, what do you find students do to, to help make it through that if it's so intense? Like, how, what are some, um, oh gosh, I'm not thinking of the right word, best practices for students to make sure that they're ready to, to take on such intense training?

Oh, that's a good question. Um, they have to be, uh, really good at prioritizing their time and sometimes making some sacrifices because the difference between PA school and undergraduate is you had some control of what you took, excuse me, all right, voices, you had some control of what classes you took, when, and you kind of spaced those out depending on their intensity. In PA school, you don't. You lose that choice, and they're all intense courses that require study. So you must become prepared to prioritize your time. And in that priority is also time to take a break every day to go do something else in between studying to refresh yourself because if you don't do that, you'll burn out quite quickly. So it's just a matter of being very, very useful with your and deliberate about how you manage your time and being willing to sometimes be flexible with things, especially in that first year.

So while you were in PA school, what did you imagine would be the most difficult thing about working as a PA? And how do you feel about that now that you've worked as a PA and you've come far in your career? Like, what was your, just biggest fear as a PA student?

That I would make the wrong decision with the patient and they wouldn't fare very well. Especially when you're talking about primary care medicine, you are trained as a jack of all trades. So we're talking about all of the things that could possibly present in front of you to be able to make the right differential diagnosis, if you refer out, you refer, or if you treat it, you treat it. I think that, and I, I still work in primary care one day a week. That is still what I grapple with because if you, we saw in the year of COVID how much medicine and the system changed in a short amount of time. Change is the name of the game with medicine. So the treatments that I learned in PA school have all turned over. Most of them are different now, or they recommend different things than what I learned. So that's the other thing is that you, you have to learn how to learn because you will be doing it forever. And you will be constantly reading, constantly understand, trying to understand what the latest treatments are. And, um, I think that that is one of the, one of the biggest challenges that I had as a fair, as a student, and, and still kind of have that. But I want to talk a little bit about some of the other nuances of providing care that didn't occur to me so much as a PA student, but oh my goodness, as a provider, how much impact that has as you prove, as you work with the patient to come to a place where they can be healthy. And that is social determinants of health. When you have 15 minutes or less with a patient to really kind of understand where they're coming from, number one, understand what their issues are beyond what you're seeing, and dropping your own biases at the door when you're six patients behind and tired. But it's those things that can either render the things that you do pretty meaningless or really help somebody out of an unhealthy state. So the medicine itself, well, you have to keep learning, and that's true. That is sometimes not the larger challenge of providing, of being, becoming a healer and really providing good care to patients. It's those other softer things that really take, um, the emotional and emotional and intellectual energy in providing care.

Yeah, and you know, as you say that, you're talking about 15 minutes. It just made me think because I've heard some other providers talk about, you know, that personal connection, you know, like to get them to trust you as a provider and stuff, you kind of have to build some of that personal connection with them. And how do you do that in 15 minutes to really get them to open up and talk to you about what could really be going on with them?

Um, in the population that I serve, and it's the first time I'm seeing them, I do mostly listening for the first five to ten minutes. And when I, and then I ask them follow-up questions on the things that I have heard. But you also kind of have to be, and this takes, I think, some courage, if you heard things in between the lines that could be impacting what it is you're about to do and the effectiveness of your treatment, to do, when I say confrontation, what I mean is gentle bringing, bringing those things up in, in a very diplomatic way to the patient and negotiating what you think from your experience might be the best way to go and be open. When I say negotiation, I mean that you'd be open to negotiation of those things with your patient after you have listened to them. Because if you listen to them, not only are they mostly likely to tell you what the diagnosis is, if you, if you're good enough, and the second thing is those things surrounding them as a person that, in that could have, um, that the treatment may or may maybe a barrier to an effective treatment for you as a provider given to them. But listening, I think, is always a good way to start.

That's great advice. So this is obviously, like, a difficult career and has its ups and downs. So what, like, how did you first learn about the PA field and what drew you to it?

I went up to, as soon as I heard my colleague, I was in the physics building at the University of Utah. I took a shuttle up to where he said the PA program was, and I walked into the office and I said, "Would you tell me about this program? Because I've never heard of it before." So they told me a little bit about it. The other thing that sold me was, um, I knew what I wanted to do. I thought I was going to go to medical school, and I knew what I wanted to do after I graduated. I had some idea, mostly of the populations I wanted to work with. That I knew what really resonated with me with the PA program was that they also had, um, and that different programs now will have different missions. That particular program had a mission that resonated with what I already wanted to do. And that just opened everything up. Um, it, and the language sometimes, you know, when you're, when you're a student and you're going to pick a place to go, listen for that language that opens you up, that is exciting to you, because different programs will have a different bend, a little bit of different bend to their curriculum, and one will really, like, your heart starts, do you feel your heart start to beat? You're like, "This is, you know, this place is going to, um, help me learn in a way that I, that it's going to help me grow." So, um, listen for those things when you are selecting a program.

Okay, that's a good thing to think about. Make sure it resonates with what you want for your future. Um, so our next question, what kind of patients can physician assistants treat?

Oh, any, any kind of patients. They really are in just about every specialty. I think there's a few specialties which are still a little new to us, and I would say anesthesia may not be a place where I've seen a lot of PAs working. Is writing anesthesia? Ophthalmology is a relatively new specialty. But the rest of them have PAs working in them. So really, it's any kind of patient that you can see in medicine is the ones that you can see as a PA. And depending on, you can also do the specialty, and then there's the environment in which the specialty is running. So sometimes you can combine those two to, um, see the kinds of patients that you enjoy seeing.

Okay, so kind of, you've kind of already touched on this next question just a little bit, but so how are patients scheduled and how much time do you have to meet with them?

So I'm going to speak from an ambulatory family medicine practice. So they schedule, there's usually some staff who do some initial triage or they listen to why the patient's coming back and can help schedule the patient the appropriate amount of time for a provider with the appropriate person. And then I come in to work, and I take a look at my schedule, which is usually, um, 10 in, like, a four-hour shift. So it's every 15 minutes. And then they'll bring the staff will bring the patient back, do a history, get the vitals, they come and tell me a little bit about why the patient's in there. And I may open up the chart to get an idea of what may have happened in the past or, uh, what kind of results they may be there to get. And then I go in there and for about 15 minutes, address whatever issue is coming up for them, come up with a treatment plan that is, uh, sound, and go over that treatment plan with the patient and either schedule follow-up or do the referral. A lot of time is spent, especially in primary care, probably in all specialties, but in primary care, and you have, when you have them backed about 15 minutes, there's a lot of administrative work on the back end of that, more than there used to be, actually. With the advent of electronic medical records, the amount of time charting just blew up. So we spend a lot of time entering all that data for patients into the electronic medical record. I think the data is good, but it, you just have to keep in mind that that adds a lot to recording what it is that you have done. Is time outside of that visit, unless you're really good at doing the computer and talking to the patient all at once. Some people are really good at that. But generally, there's some time documenting and following up on results and things like that.

Okay, so and that kind of somewhat addresses our next two questions too, is like walking through a typical day and how busy is it? But is there anything else that, give me, you talked about charting kind of at the end of the day and how many patients you see. Anything else that you would kind of experience in a typical day as a PA?

You have to be able to communicate with your, with every member of your team about the needs of the patient and understand the, the team members that you're working with as to who you need to talk to about what kinds of things and to communicate these, those things in an appropriate way, both professionally and just in the language of medicine. Because if you learn that language, it takes less time to communicate those things. So it's learning the language of medicine, being in a, make sure that the communication is professional, and understanding the different roles of the team really can help you get the best treatment for your patient. Back to a little bit of self-care. I know that I have to take a break in between shifts sometimes. You get behind enough that you can go all the way through without taking a break, and I've done that before. But what I have found is that I've begin to feel like those last patients of my day paid for me not taking a break in between. So I have now realized that taking a break in between and making sure that that takes place is better for my final patients of the day. It refreshes me so that I'm, I'm not decision fatigued at the end of the day. And I know it sounds funny to talk about that, but really, you, I think it, if you want to be sure that you're providing the best care that you can to everyone that comes to see you, you have to deliberately schedule in self-care. Same thing with studying in PA school, you must deliberately schedule those things in, the things in there so that you are primed to learn. But I think there's a lot of healthcare workers that go long periods of time without breaks, and they're probably fine. I just found that, you know, if I took at least 15 minutes, half an hour in between an eight-hour shift to recoup, it's better care.

So, um, you have a pretty interesting career, I feel like, since you're on the director of the PA program at UVU. So tell us a little bit about your career path and how you got from PA school, working as a PA, to your current job now.

Um, I, when I graduated, I, um, found that I, you do a lot of education to patients. In fact, that's at least half the, or at least a portion of the time or fraction of the time that you should be spending is educating, helping educate them about their health and what's going on with them. Um, I liked that. And so, if a couple years after, they asked me to come back and teach a course that was relevant to the medicine I was practicing at the time. And I, um, I enjoyed thinking about teaching in that way, both in how I did that directly with the patients and kind of like from, I'm going to call it an architect's perspective, like how do you design things so that people learn better and the knowledge is shared in a more effective way? I liked thinking about things that way as well. So when I started that, that's what really led me to keep going and teaching is to, to see if I could think about innovative ways in which to share that knowledge. I enjoy that.

Okay. Um, and then so you went from the U, and then you did, you go overseas after the U and then come back to UVU?

I went from the U, and then I worked at the University of Texas Southwestern for about five years. And then at that point, Australia was wanting to incorporate that role because they have rural areas, of really rural areas, remote areas where they have a hard time keeping providers. So they wanted to develop that role. So I went over to the University of Queensland and spent another five years there, helping them develop that role in the, uh, context of the Australian healthcare system. And then went back to University of Florida for a couple years and came back to, to Utah.

Yeah, so you've been everywhere. That's kind of exciting, you know, to, to see all the different places and see how the, the profession plays out in all of those different places has been very interesting. Um, but each time I've gone to those places and seen even different regions of the country, how that role plays out in, in the healthcare of the people in that area, I've always enjoyed it. There's been good things about everything I've seen, and it's just solidified my decision I made about, uh, choosing this as a profession, which wasn't, I thought, you know, if I went to PA school, I could do it for two years, and if I really liked it, I'd go back to medical school. But I just, there was no need to after doing this. I've enjoyed it a tremendous amount. So it fulfilled you. That was kind of where it took you. That's good.

So on that note, if you had to pick something specific, what would you say is the most, absolute most rewarding thing about your current position?

Um, from the, the one at the, as the director of, uh, Utah Valley University, helping, I always get excited thinking about educating the next generation of physician assistants to provide great, provide great healthcare to people and to people in need because I've seen, I've seen that happen. But also have them enjoy the choice that they made as a career and hopefully enjoy the learning process. It's tough, it's challenging, but the nice thing about PA school, there's not a lot of it that we teach you that's not relevant to what you're going to do. We're, we're all about, in that short amount of time, it's all important. So that's what makes that a lot of fun to do. Um, that's a lot of pressure on students, I think. But as soon as they can see the clinical year and the, and the lights, and they can go out and start using what they've learned, that's always exciting. I've always loved to see students learn those things and go on to have tremendous careers and utilize their skills to make, really make a difference in a lot of areas of healthcare. So that's been, that's really rewarding.

That sounds exciting. It's always fun to see that light, like you say, in the student's eyes, and they love what they're doing and they feel like accomplished. So, so another aspect, you know, medicine, not every patient is easy, not every case is easy. So what's probably the most challenging situation you've seen as a physician assistant?

So, um, I, I spent some time at the University of Utah Department of Pediatrics as the foster care healthcare provider. So if a child was removed from state's custody, they came to see me first, and then we connected them back with their healthcare providers. Um, probably some of the more challenging aspects of, of being a PA was related to that job. And not very many jobs are you able to move into people's both physical space and emotional space because it's a highly vulnerable time in that person's life, generally, when they are there to see you. So you invade their, their space physically, and in order to become a good clinician, you must solicit information from the patient. So you're probably emotionally in their space as well. And when, when young patients are in that kind of vulnerable position, some of those things were probably some of the toughest experiences I've had, but most rewarding because they gave me a team of people to help navigate those systems that helped those patients get what they needed. It was, but, um, I think that not, yes, not all patients are easy, and there's tough things that you're going to see. Like, I also, I sometimes wonder how it's like for providers in an oncology practice. You must probably get used to, um, talking to people at a certain point in their lives and confronting issues of death in that kind of practice. And for some people, that's too difficult. So yes, every kind of practice has its own difficulty. Uh, you're not probably not going to get away from that. But [Music] if you love what you do and you feel like you're making a difference and there's a purpose to it, it becomes more of a challenge that you feel you're helping, um, both them to, to overcome, and, uh, that you're challenged to learn things about the system that you can help patients get what they need. But yeah, different practices would definitely have different challenges. And one thing I wasn't, I knew I didn't want to go into emergency medicine because I didn't want to be the person who held somebody's head together. That was, that was the kind of hard that I didn't want. I, I was okay with the other hard, it was challenged up top, emotionally, but that was the kind of challenge that in my clinical practice, I was up to meeting and felt good about. But thank goodness for those people who are wanting to hold, you know, do work in those emergency situations. So every kind of practice needs every kind of person who's ready to do that kind of work. Um, so you just kind of, you, as you go on clinical rotations and you get exposed to this different kind of medicine, you'll feel one that feels good to you and like, this is kind of what I like to, you know, these are the challenges that are meaningful, most meaningful to me.

That's great advice. Yeah. So jumping back to PA school and undergrad and maybe even high school, what opportunities helped you grow and learn the most in your journey to becoming a PA?

This is before or during PA school, you mean? Yeah, like any time before you officially were a PA, like, what would you say were the most valuable experiences and opportunities to getting to, to getting you to where you are today?

Um, I think that being able to have a mentor that didn't just tell you how great you were, but pushed your boundaries a little bit, and sometimes told you not just the good things about you, but the things that you needed to change in order to be better, was, uh, invaluable. Because when you go into medicine, has its own culture, and some of those cultures in different areas are more likely to, um, convey feedback, you know, in all different kinds of ways, right? But, um, I, those ones where I was told, "This is, these are the areas I needed to change and become better," uh, in ways where I knew that they actually cared about me, that was probably some of the best experiences I had. And I had a preceptor in, in PA school that really just was tough because he would tell me everything I did incorrectly right after I got other. But I learned from him, and I still, ca, I kept in touch with him years afterward because he made me a better PA, you know, much better. So you need to get used to hearing feedback, or have somebody to give you that kind of feedback that helps you become a better, doesn't, isn't well, tear you down just to tear you down, but it is criticism that helps to build on the talents that you already have.

That's really good advice. Making sure you surround yourself by one or more people that really help you become your best self. Yes. Yeah, that's great.

So what do you think is one of the hardest things you have to do as a PA? Or, see, the hardest part of being a PA?

Um, when you either need something for a patient that you can't get covered, sometimes the administrative aspects of practice are limiting to what it is that you would like to see done in your treatment plan. So those are a little bit challenging. Or when you get a patient who, you know, that, that you haven't seen [Music] improvement with, can be sometimes a little bit challenging for whatever reason that there, there isn't the outcome that you would like to see in your treatment with this patient. Sometimes those get a little bit, um, difficult. But I would say the most difficult thing for me is knowing that there is services needed or a certain kind of treatment needed, and their, the administrative barriers that stand in the way of that are sometimes a little bit exhausting within a system to get that for the patient. So, uh, there's a lot of administrative overwork that's not just practicing medicine, but understanding how to navigate services for your patient. I wish that were easier. I don't see that becoming easier. But [Music] those are probably the hardest things for me.

So we've talked about where you started and where you are now. So looking back, how has the PA profession changed as you've seen it?

It's definitely gotten so, when I was in PA school, I, I was 22 years old when I got into PA school. I was by far the youngest person in that class. So the, the average age was well into their 30s. So it was a, it was a second profession for a lot of people. Now, uh, you see the same, the same people that could choose to go to medical school are choosing to go to PA school. And you asked, actually have to recruit or make or say that we, we consider non-traditional students in the PA school because it's, it's, as it got more mainstream, the students that applied to it were more like they were for medical school. The specialties, most of the jobs when I graduated were in primary care or in a primary care field, like emergency or urgent care or ambulatory primary care. Now, it's the specialties are expanding and needing PAs so much that a larger percentage of the graduates go into specialty care because that's where the need is. Um, just now, it's interesting you asked that question because the state is considering legislation at this moment that makes PAs more independent. So we were a dependent license to practice medicine two years ago, well, last year in the state. And I think we're getting coming close to the time where it's not a dependent license anymore, which could be, mean independent practice. So that is a, that is a huge professional shift. And I don't know, I can't predict what the intended consequences of that are. I think the intended consequences are that PAs may be easier to employ. So if you remember when I talked about the administrative stuff that I didn't like, most people, most of the healthcare providers that are, you're working with probably don't like that either. And when you have to supervise a physician assistant, it increases your administrative load. So that's why with becoming more independent, um, PAs will probably more likely to be employed because they don't come with that administrative, additional administrative load. However, I was so happy. I have never been to satisfied or not enjoyed the relationship I have had with a supervising physician and practicing with that person to provide medicine in kind of a team approach. Certainly, they're the time that you learn in PA school, you learn a lot, you learn a ton. But in medicine, when someone's graduating, even if it's in primary care, they've had years of additional training in residency. So they are, if you were looking people out of the gate of residency and out of the gate of PA school, it would be nice to have that relationship so that for a little while until you can at least get to the point where the things that you do routinely, you can do them independently. Because I do that, I think PAs do get to that point in their career where they, they're okay to do that. Um, I just worry for, with all of that learning from such a broad base, that PAs, that we want to keep a mentorship or a collaborating relationship for a while, um, to help to support new graduates. But, thank you for asking that question because that is a major shift in our profession right now.

Well, and that's good to know because, I mean, I'm going to skip down a couple questions because that's actually one that we have on there is like, how much time right now do you work with your supervising on a typical day? How much interaction is there?

I see. So if I had, so I worked clinically in a clinic yesterday, and I had, um, 20 to 24 patients. I, on average, I ask him, I probably go ask him questions about two or three a shift. Sometimes I, not at all. Depends on what's coming, you know, if I feel like I, uh, want his perspective on a complex problem, I'll go ask him. But it actually isn't, doesn't end up being that much. And I probably ask my supervising doc more questions than the average PA does. Um, so a lot of them will go a long time without, uh, getting a conceive, a bat, or panel of patients in a day and not really have to ask the supervising doc something. But the supervising doc will then go through and review the records, I think, according to the plan that you practice. That's what's adding on the time for the doc is to, to go back and review the records. But, um, we'll see where this goes. But it's always nice to know, you know, and even if the law changes, I will probably still go asking questions. That's part of that whole team-based care, right? Just making sure that, you know, we're providing the best care we can. If we have to have people that we bring in to, to know what to do. Yes.

So I would love to hear more about what your specific job is today. Like, what is your scope of practice, your specialty, and maybe how does that differ from PAs that practice with you or that you know?

Um, so I'm at, uh, I'm staff at, uh, Mali'a Free Clinic, which sees underserved, uninsured, uh, patients. A lot of them are from traditional underrepresented backgrounds, and from a primary care perspective. So I see, I think the, the depth of medicine I see is quite large. I mean, I can see follow-up, uh, cancer patients and an ear infection and anything in between there because the, and this is also the, because the population that's coming to me, this is their only point of access. So I see quite a broad scope of medicine in my practice. That's why it's probably why I was going to say, ask my question, my supervising doc questions more than the average PA does. But I think that's probably why it's because a lot of stuff walks through this door that, and I don't know, rocks through other primary practices. But, um, I think the, in specialties, so it's like in orthopedics, when I was working in Texas, um, you hired an orthopedic PA, and they did a lot of the pre-op and post-op care. Whereas orthopedic PAs in Utah actually participate in the surgery more than I think that they did when I was in Dallas. So it also depends on the region that you're wanting to practice in as to what is common practice to utilize PAs in different specialties. But I think that, I don't think my other than the, the population in the scope, my experience in ambulatory primary care probably isn't too different from other ambulatory primary care practices at this point.

Okay, um, let's see. I think you kind of answered our next question about, you know, expectations, you know, with your practice hours. Um, I don't think you guys do call up at Mali'a. Um, but so, and, um, so besides your work in the clinical and academics, I know you've done a lot of work, um, in your health advocacy work, supporting underrepresented, um, communities. Can you tell us a little bit more about what type of work you do and why you feel it's so important?

So I worked with the University of Utah to, and Salt Lake County, to address some health disparities that were within the Pacific Islander population in Salt Lake City. And one of the best ways that I thought to do this was to work with a community health worker within the Pacific Islander community to develop, um, ways to decrease their access to primary care services and to make them aware of, um, how to, uh, the impacts of chronic disease. And, um, the interesting thing about that work is it changed significantly during COVID for this particular population who ended up being, um, impacted, uh, a great deal by, um, [Music] by the pandemic in ways that were maybe different from from other populations. But, um, I think that health disparities are something that we need to be concerned about. Not just health disparities, really any disparity in our society. They have been there for a long time. At least as long as people have been collecting those, that information about populations, those disparities have existed. And the thing I get a little bit, um, passionate about is that we've stared those numbers in the face for many, many years. And it, when people argue that there isn't somehow racism built into systems, I would like them to explain to me how those disparities exist for so long. Because it's not that it would be to sort of say that there's a, that the difference belongs to the population that, that's impacting. Is we keep, those days are over to say that. So we, uh, how we go about, um, advocating for that, uh, in my job as a, as a PA educator, um, because not every PA or not every professional that, um, comes out is maybe as passionate about disparities within populations. I did the Pacific Islander population because that was when I felt I understood a little bit more than other populations. But, um, you, I always try and look for ways to educate patients so that they aren't the, the decisions that they make personally, the small ones in clinical practice, aren't perpetuating those disparities. Because more than advocacy, which we've been trying for a long time, it's more of a, those small personal choices that you make every day as a provider can help decrease or stop perpetuating those, um, disparities that we continue to see. And there's been research that shows that those decisions that providers continue to make decisions that somehow perpetuate those. So that's one thing that I think students can do is be mindful, both in two ways, both globally in their advocacy, and those decisions that you make every day as a provider when you're tired. One day, I don't want people to think that this is a bad choice because I think I've talked a lot about self-care and not getting burned out. And it's, you do, you can get burned out. But, you do, you get behind, and you want to make sure that you see everybody and you give everybody the same treatment. But it's that, those times when you're in that situation that those decisions about you make in the room with the patient and how you treat that patient that can help decrease disparities. So if, at this point, after having done some global advocacy, which I hope to continue to be involved with, my bigger challenge is to help every PA that comes out be mindful of those small choices that they make as they care for people in a diverse nation.

I'd love to hear your passion for that. You can hear it and feel it in your demeanor there. Thank you. So I guess as we're getting closer to the end of this interview, I would just like to hear more about what you love most about your job. Like, what is your favorite thing, highlights of being a PA?

Um, so this is going to sound cliche, but I don't think there's anything wrong with cliches when they're good. So here we go. I think that every day I wake up when I'm in this profession, I have not questioned once why I'm doing it. I, I sometimes question the processes of how it gets done, and that's fair enough. Processes can change and become better. But the, the real reason I chose to do this, I have never questioned that. And I have not been let down yet by the opportunities of my professional learning has brought to me to be able to fulfill the original purpose I saw in it. And so I think that those, every job or every, I'm not going to call it a job, every career choice that you make, you can choose to, um, make choices to view it or do things in your daily process that bring you closer to the original purpose that you saw or take you away from that. But the nice thing about PA and medicine is that I have never felt like I couldn't make choices that brought me closer to that purpose. And if you don't take your eye off the prize, which is providing great healthcare and taking care of people, you will always see the light through any process that helps you make decisions, both as a team, as a provider, as an individual, when you're trying to take, making sure that you're able to make those decisions on first patient to last patient, and making sure that you understand the systems well enough to help your patient. Um, and I love, loved that about this profession. Um, and also about academia, it allows me to make choices that and be creative about how I'm true to that original purpose. But it's full of purpose, and I have loved every minute of it.

That's awesome to hear. I feel inspired. I guess the very last thing I want to ask is, what advice would you give to any students contemplating a career in PA? And like, what could they do to prepare for life as a PA? Just, what's the advice you would give?

I have some real practical advice. I would have someone, um, help you with your personal statement for an application because sometimes if we write those in isolation, um, if you're like me, I probably, you start writing about yourself and it gets, you know, you don't bring out all the great things that you actually have that, um, you see some things that you've minimized in there that really you should blow that up because that tells me so many great things about who you are. So have somebody work with you on on your personal statement and bring those things out. Get as much experience as you can. And I know that is difficult, um, but try and use your connections to get exposed to as much patient care so that you know that, I, I'm assuming that everybody that starts walking in this direction wants to take care of people, and that's fantastic. Medicine is one way to do that, but you have to be comfortable. We talk about invading people's space. You have to be comfortable with that in many ways. And there's other ways to help people that don't involve that that may be great. So get that exposure. Um, and the other thing is is, um, try to, if there's something, if there's a certain aspect that's specific about medicine or patient care that is important to you, try to do something, um, in the, in any way that you can, or get involved in some way that addresses that specific issue so that when it's time for your application, number one, you, um, have sort of tested the waters as far as what your passion is, and then we can, we can see that what you have demonstrated aligns with what you're saying. And so that makes a very strong application. Um, but look for all the opportunities that you can to be exposed to different areas and to be of service.

Thank you so much, Karen. This has been fantastic. Um, I mean, we've known each other for years, but I learned so much more about you, and it's been really fun. And I think you've given some fantastic advice for, you know, our future physician assistant students, and we're so appreciative of your time.

Well, what an honor to be asked. And thank you both for, um, the questions and my opportunity to, to share.