Rachel Stappler, PA-C is from Coos Bay, “born and raised”. She has an outpatient practice at North Bend Medical Center as well as privileges at Bay Area Hospital. NBMC is the largest clinic on the South Coast, it has a 72 plus provider clinic and 4 satellite clinics. This is a multidisciplinary, hub for the Coast. The Coast has only a couple critical access hospitals. Rachel has had hospital privileges for 8 years now and also has an outpatient internal medicine and pain management practice.
Rachel is sharing the background on what happened in the chaos of COVID19. She received a text message March 21st from an NP who was notified of a process of drafting a letter telling employees everything was going to be shut down. She immediately called her doc to find he knew nothing of this. 10:30 am the following day, Monday she and the entire clinic system received an email from the clinic medical director stating that the clinic system was closing. The clinic laid 40 people off the Friday before so, they knew something was coming but they didn’t know what. Now they have upset employees, uncertainty, inappropriate information disseminated, and a lot of upheaval in the clinic.
Meanwhile, the ER volume is down but the truly sick people are coming in and is bursting with medicine admissions. They are trying to catch up now and working to iron out communication which has been instrumental. The hospitalist team is under increased strain. Most hospitalists practice strictly inpatient medicine but there is a subset of hospitalists that also have outpatient medicine due to the volume of patients in the community needing outpatient care. Hospitalist/inpatient medicine and they are all physicians, which are very coveted positions. The hospitalist team has discussed adding a PAs and NPs to this service in the past but they have arrived there yet. The team felt it would be 2 years minimum. Rachel feels the reluctance is from a lack of understanding and experience with PAs and NPs. They haven’t worked with a PA closely, there isn’t a clear understanding of capacity and capabilities combined with a trust issue too.
Rachel was trying to figure out where her next adventure is going to be when her doctor came to her and said, “we don’t have enough hospitalists”. Some of the internists stepped up and said they would cover for some of the hospitalists they are preparing for the coming days. She was asked to come and work with the hospitalists. This is the first time here a PA has been included.
Her team is developing all these guidelines now on who to test for COVID19 now based on other institutions. All sorts of patients are being admitted. They are conducting 8-hour shifts, admitting all sick patients and averaging 2 people every hour later in the shift. It’s a jigsaw puzzle, you don’t know any history on some these patients. It is challenging but in a good way. Rachel says “it really pushed me to the top of my scope as a PA.” She is receiving feedback that her notes are really good and that her work is solid. She hopes to alleviate doubts through this opportunity and prove herself and her profession in the process.
For now the main clinic is closed with the exception of the urgent care and the newly created respiratory clinic. However, she was able to pick one staff, an LPN to work with her who has been with her practice for almost a year and a half now. Now some employees are working remotely with minimal and essential team members only in the clinic. Rachel logs in remotely to see her regular patients in addition to rounding on her patient’s in the hospital and the hospitalist shifts with her supervising doctor. The respiratory clinic providers are rotating shifts, being sent a calendar invite to know when their next shift will be. Hospitalist shifts are 8 hour shifts, which consists of running codes, rapid responses in addition to carrying the hospitalist phone to answer calls for the service, it can really inundating but such a great opportunity simultaneously. This is an incredible opportunity for the community and PAs in general. We are moving and progressing. She is looking at this opportunity to pave the way for PAs to help the profession progress.
In light of practicing hospital medicine, they still have their outpatient clinic. They take care of patients through the portal for needs and by phone. Considering all the calls which was almost 200 daily in her office prior to COVID crisis this has fortunately decreased and the patients are understanding of the time it takes to respond.
For the immediate care clinic Family and Internal medicine providers are going to take the load off other doctors so these patients don’t end up in the ER. The clinic call schedule continues to run to help offset the urgent care load when it is needed.
The ER, orthopedics and general surgery employs some PAs, but otherwise Rachel is the only PA for the medicine service. Rachel says she has been really humbled by physicians coming and asking what she thinks about a situation and how we can all take a team approach and draw together and this difficult and unprecedented time. They all lean on each other. It has created strong bonds and collaboration. This is medicine. This is the standard of care taken to another level out of necessity.
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