The PA profession’s rapid growth combined with the ever-changing health care landscape means you won’t find many people involved in supporting the vocation who have a ton of time on their hands. For that reason, the decision to take on any additional challenges is considered with great care.
Yet for the past five years, leaders from the “Four Orgs” — AAPA, ARC-PA, NCCPA, and PAEA — have cleared their schedules to converge in Colorado for two days each August. They convene at the prestigious Aspen Institute, a place known for attracting the nation’s greatest minds, gathered there to solve pressing problems.
And what is the problem this group aims to solve? How to put the mouth back in the body.
In 2009, when a University of Colorado colleague “dragged” Anita Glicken, MSW, to a small-group meeting of various health care providers who were discussing oral health, she couldn’t have predicted that it would lead to her spearheading a movement. But the topic — the lack of dental care for many underserved populations — struck a nerve with Glicken. She’d always been passionate about overlooked and undervalued health issues, and now she realized that oral health was one of those issues. What’s more, she recognized that the PA profession could do something about it.
“It was clear to me that the profession is unique in its potential capacity to work together, and it could leverage that capacity to make a difference for patients,” Glicken said.
She asked the funders at the meeting — DentaQuest Foundation, Washington Dental Service Foundation, and Delta Dental of Colorado — for resources to bring together the four PA organizations so that they could begin integrating oral health care into PA education and practice. It wasn’t the easiest sell, but Glicken was convincing, and she walked away from the meeting with $60,000 to fund the first PA Leadership Summit in Oral Health.
There’s no precedent for all organizations that support one health care field tackling an issue in a mutually supportive way. This type of collaboration has recently come to be defined as “collective impact.”
“It was kind of that magical moment; the right leaders had the vision of how to work together to create a network,” said Cynthia Lord, MHS, PA-C, from Case Western Reserve University who’s been heavily involved with the initiative since 2010.
Each year the Four Orgs come together to submit one cohesive grant. Since 2015, PAEA has served as the fiscal agent (it had previously been managed by the nccPA Health Foundation and the University of Colorado). Glicken is the primary investigator, working across the various organizations to pull all the pieces together.
Organized thusly, the Physician Assistant Leadership Initiative on Oral Health began its efforts with PA education — the best place, the group figured, was to start when PAs are just beginning to learn. In 2008, just 30 percent of PA programs taught oral health, so the group went to work educating the educators.
They talked about the strong connection between oral health and other chronic diseases like diabetes, stroke, and adverse pregnancy outcomes. They shared resources like Smiles for Life, a free online curriculum that makes it easy to integrate oral health into the classroom. And they said that this was an opportunity for PAs to be leaders in the health care world.
By 2014, the number of responding PA programs teaching their students about oral health more than doubled, to 78 percent.
Glicken attributes this success in large part to the way the movement is organized. “I think the attraction for those who have joined is largely due to the fact that the four organizations have been able to work together,” she said.
According to Lord, oral health was the perfect topic for the PA world to join forces on. “This was not threatening to anyone, probably because it was a new area,” she said. “We bring our unique strengths and share among each other without infringing on each other.”
Every year during the Aspen meeting, the organizations work collectively to identify what each can contribute over the coming year by leveraging their specific resources.
AAPA has formed a special interest group in oral health. NCCPA and the nccPA Health Foundation have awarded oral health grants to PA faculty. ARC-PA has evaluated where oral health education can fulfill numerous standards. PAEA has sponsored several oral health workshops for faculty. The list goes on.
The collaborative model has been effective, and other health professions are taking note.
“All the external partners [who are invited to join the Aspen summit] are typically astounded when they look at how much the PA profession gets done every year in the area of oral health,” Lord said.
The nursing initiative adopted many of their strategies from the PA model, including holding their own summit on oral health.
While the oral health movement has seen tremendous results in a short period of time, its leaders have no intention of winding down their efforts.
“I think the reality is there still are a lot of people who don’t appreciate the impact of oral health not only on patient care but cost to the system,” Glicken said. “I would be remiss if I said we didn’t have a long way to go in educating the PA community.”
The PA Leadership Initiative has now begun to focus on the interprofessional opportunities that oral health presents.
“Look at what not being interprofessional did to oral health. Keeping dentistry and the practice of medicine separate did not lead to good outcomes,” said PAEA’s Academic Affairs Director Zach Britt.
PAEA recently held its first Interprofessional Leadership Program, which brought together teams of students and faculty from programs across the country to learn about oral health. “Leadership and interprofessional practice are big, hard things to teach,” said PAEA’s Academic Affairs Assistant Chief Olivia Ziegler, MS, PA. “Oral health is a small topic that can be used as an exemplar.”
Another focus going forward: to educate practicing PAs.
Ziegler said that while efforts with students have been successful, the next hurdle will likely prove more challenging. “Students have drunk the Kool-Aid — they get it. It’s part of their routine,” she said. “But when they go to their clinical rotation, they often find clinical sites that are not prepared to implement oral health. So the next step is to help students lead by educating the preceptors.”
Glicken is, unarguably, the lynchpin of the PA oral health initiative, but recently a small advisory group was formed. “I see it being a self-sustaining network with individual champions who really can continue to move the agenda,” explained Glicken.
Lord said she’s inspired by the direct impact that oral health can have on a patient’s health, and proud that the PA profession has taken on such a strong leadership role. “As we approach our [profession’s] 50th birthday, I think back to Eugene Stead and Charles Hudson. Would they not be proud?”
The the PA Leadership Initiative in Oral Health is supported by the National Interprofessional Initiative on Oral Health (NIIOH) with funding from the DentaQuest Foundation and Washington Dental Services Foundation.