Tucked away in the charming city of Syracuse, New York, the Le Moyne College PA program trains 150 PA students each year to excel in the delivery of primary health care services with an emphasis on patient care in rural and underserved communities.
Recognizing that these communities are among the most vulnerable in the wake of the opioid crisis, Program Director Mary Springston, MEd, PA-C, sought and received supplemental funding from the Health Resources and Services Administration as part of a Primary Care Training and Enhancement grant. This funding allowed the program to require student Medication-Assisted Treatment (MAT) waiver training and provide students with practical experience in administering MAT.
Upon learning of Le Moyne’s plans to further instruct their students about opioids and opioid use disorder (OUD), PAEA reached out to Springston to learn more about the project’s scope of work and gain greater insight into the different ways that more than half of all PA programs are embracing the aims of PAEA’s MAT Waiver Training Initiative.
Can you elaborate on how your students will complete MAT training and gain relevant MAT experience?
Le Moyne took a multi-faceted approach to providing training for our students in pain recognition, pain management, and addiction that includes:
- An eight-hour self-directed learning module that provides students with information on the physiology of pain, pain management in an outpatient setting, guidelines for prescribing pain medication, alternative strategies for managing pain, addiction, and treatment of OUD
- Student opportunities to work with primary care providers who treat addiction in their practices using MAT, which complements the didactic training and allows students to see strategies put into practice
- An initial four-hour training for all second-year students beginning in 2019, followed by a debrief and supplemental education to support them in completing the additional 24 hours of specialized training to prescribe buprenorphine following licensure
How do you think MAT waiver training will benefit your students?
Having our students already familiar with medications commonly used to treat opioid addiction (methadone, naltrexone, and buprenorphine), and knowledgeable about the implementation of these medications through curricular waiver training, will allow them to enter the workforce immediately prepared to help treat substance use disorders and sustain recovery efforts.
What prompted your program to pursue additional funding that would support MAT waiver training for students?
The opioid crisis has disproportionately affected rural and resource-poor communities in our state. By enhancing and augmenting the existing curriculum to include focused instruction on pain, pain management, and addiction — and by increasing the number of trained preceptors — more primary care and other sites can offer interventions to combat the opioid epidemic. Having our students complete their training early in the clinical year may have the advantage of proximity to their didactic learning and give them an opportunity to practice some of the skills they will develop during their rotations.
Are you anticipating or has your program experienced any resistance or barriers to formally training students in MAT?
Lack of buy-in could easily sabotage the potential success of any MAT program. We witnessed similar barriers during the HIV epidemic when some providers and health care administrators didn’t want people living with HIV in their clinical settings. Outcome studies and research will help get some staff, students, and community members on board for MAT, but evidence may not convince everyone to embrace a treatment such as buprenorphine (Suboxone®) for OUD.
Opposition can take many forms. But strategies that are useful include:
- Education: it is crucial to understand the brain chemistry of addiction, the difference between addiction and dependence, and that MAT is not “replacing one drug for another”
- Sharing evidence-based journal articles
- Semantics: talking about MAT as a tool for managing substance abuse disorders rather than “harm reduction”
- Using a health analogy: the condition is similar to other chronic conditions such as diabetes, for example, the management of which requires both behavior and lifestyle changes and medications
- Affirming the value of other aspects of treatment
- Providing structure
- Addressing concerns about diversion
- Inviting patients to share their stories with students and staff to put human faces on the data
I’m optimistic that as PA educators address the stigma and social determinants of health surrounding the opioid epidemic in their curriculum, barriers will lessen and progress will be made.
What advice would you offer to other programs that are interested in requiring that their students complete MAT waiver training?
Every day, more than 130 people in the United States die after overdosing on opioids. This is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total “economic burden” of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.
PA educators need to engage their students early on with regard to these and related facts. Throughout both the first and second years of PA training, a student’s knowledge base should be expanded and scaffolded via both didactic and clinical rotation experiences.
The opioid epidemic is the crisis of the current generation, the way the AIDS epidemic was the crisis of the previous one. Prior to graduation, students can be empowered through knowledge, skills set training, and technical proficiencies. They can develop the tools necessary to meet the epidemic squarely and confidently as soon as they graduate and enter the workforce.
In addition to achieving 100 percent MAT waiver eligibility among all PA program graduates and faculty, the MAT Initiative is committed to encouraging all programs to require their students to sign up for NPI numbers. How has tracking NPI numbers benefited Le Moyne?
Le Moyne has been using NPI numbers to track graduates for several years. As you can see from the data listed below, for many years more than 50 percent of Le Moyne PA graduates have worked in Health Professional Shortage Areas (HPSA) and Medically Underserved Areas/Medically Underserved Population areas.
Program Completers Working in HPSA & MAU/MUP Areas
|Le Moyne College Class||2011||2012||2013||2014||2015||2016||2017|
|Total # of Program Completers||40||39||42||41||54||53||74|
|Employed Working in HPSA areas||12||16||14||9||15||15||19|
|Employed Working with MUA/MUP||8||3||3||5||7||2||2|
|Employer both HPSA and MUA/MUP Areas||5||8||7||6||13||11||19|
|Unknown Employment Location||0||0||0||3||4||2||9|
|Total Qualified Employers Tracked||25||27||24||20||35||28||40|
|Ratio of Qualified vs. Not Qualified Locations||25/40||27/39||24/42||20/38||35/50||28/51||40/65|
|% of Known Graduates Working in HPSA and MUA/MUP Areas||62.50||69.23||57.14||52.63||70||54.90||61.73|
Many of our students enter Le Moyne for its mission focused on caring for the whole person and the impoverished and socially disenfranchised citizens among us. These students and faculty have a strong sense of serving humanity and take pride in making a difference. As a dedicated faculty team, we thrive on the challenge of creatively dealing with complex human needs in the face of limited health care resources.
Prior to collecting NPI numbers, how did your program track alumni?
Prior to collecting NPI numbers, data were collected using alumni surveys and both formal and informal conversations to “track” the information. We encountered typical problems, ones that other programs have experienced, including lower than expected response rates, confounding our data.
Why is collecting NPI numbers more effective for tracking alumni than other tracking methods that your program has used in the past?
Prior to collecting NPI numbers, and based on primarily anecdotal information, we believed that we were getting a number of students out to medically underserved areas but did not have hard evidence. When we were able to collect the information through NPI numbers, the actual data showed even better results than we had anticipated.
Evidence-based data underscored the important job our faculty was doing and served to incentivize them to continue and enhance their lectures and discussions with our students. Perhaps even more importantly, it allowed our department to promote our primary care mission — attracting those who seek to make this a more just society.
How does your program obtain graduate NPI numbers?
Step 1: Search the NPI database by first and last name (and by state if it is known)
Step 2: Click on the NPI number
Step 3: Record the NPI number and address of practice
Step 4: If not listed, search the address online to find the setting
Step 5: Find the HPSA and MUP for primary care
Step 6: Record these data
Step 7: Total the class HPSA and MUP and calculate the percentages
We anticipate some limitations using the NPI number to track alumni. Since the NPI number is strictly a numeric identifier and does not carry information, it will be important for us to continue to track where our alumni are practicing by state and specialization. Our plan to address this is to verify that the graduate is still at this practice site by going to the website of the listed practice.
How do you think other programs could benefit from collecting NPI numbers?
Data collected using NPI numbers can help determine the trajectory of a program’s goals and objectives. Changes and augmentations can be made when and where they are needed; feedback from newly graduating students as well as alumni can help develop the trajectory of a program’s course over time.
Empowering underserved communities to thrive requires interprofessional practice and work readiness. At Le Moyne and the Purcell School of professional studies, we are doing just that. Teaching advocacy, role-modeling, and didactic work, as well as hands-on experience, fosters one of the fundamental tenets of the PA profession: to respect the health, safety, welfare, and dignity of all human beings.
Funding for this initiative was made possible by grant no. 1H79TI080816-01 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.