Board Member Reamer Bushardt Testifies at COGME Hearing

PAEA Director at Large Reamer Bushardt, PharmD, PA-C, discussed ways to protect and support PAs and other members of the health care workforce during the COVID pandemic in his testimony at a panel hosted by the Council on Graduate Medical Education (COGME) last week. Bushardt, a longtime PA educator and a clinical and educational leader, currently serves as senior associate dean at the George Washington University School of Medicine and Health Sciences. He joined the PAEA Board of Directors in January.

The panel discussion, “Sustaining and Expanding the Health Workforce in Response to the COVID-19 Public Health Crisis,” was hosted by COGME, a federal council that advises the Department of Health and Human Services on issues related primarily to graduate medical education but also more broadly to the U.S. health care workforce. Panelists also included physicians, nurses, and policymakers.

In preparation for his participation on the panel, Bushardt had spoken to three groups of health professionals in the metro D.C. region: (1) frontline providers, including physicians, PAs, and advanced practice nurses treating individuals with COVID-19, (2) providers in inpatient and ambulatory care settings not directly tasked with the COVID-19 response, and (3) leaders in the GW Graduate Medical Education community and clinical operations administration who are helping shape the system’s pandemic response.

A “few key themes emerged from these conversations,” Bushardt noted. The first was that regulatory and practice barriers have “limited the current workforce from practicing to the top-of-license and hampered nimble staffing during the pandemic response.” One effect of these limitations, said Bushardt, was a “supply-demand mismatch,” which meant that many providers in non-COVID-related specialties are being furloughed or laid off at the same time as health systems are seeking to expand their workforce in response to the pandemic. “I have also observed barriers and obstacles at all levels to the integration of PAs into care models for which they are fully competent to serve,” he noted.

A second theme was the need for protection and support for the frontline COVID-19 workforce that is caring for affected patients and families. “The physical and emotional strain on our health care workforce during the COVID-19 pandemic have been considerable,” he said. Providers he spoke to reported concerns around “issues of safe transportation to/from work, child and elder care challenges, access to food and healthy meals during long work-days, and financial concerns stemming from pay cuts or increased COVID-19 expenses,” such as paying for hotel rooms near the hospital.

The third theme concerned the mental health and emotional well-being of frontline workers. (Bushardt also noted “to a lesser degree, feelings of guilt expressed by team members not in frontline roles.”) Frontline providers he spoke to expressed “daily fear, anxiety, fatigue, high-stress work conditions, emotional distress over high criticality and mortality rates among COVID-19 patients, and stress related to ethical dilemmas,” as well as a strong element of “teamwork and compassion for one another during the pandemic.”

Recommendations for Change

For each of these themes, Bushardt and the other panelists made some recommendations for changes in health care management, regulations, accreditation, or education to better prepare the nation’s health care workforce for future pandemics.

In written remarks, he offered additional testimony related to two other panels on the pandemic workforce convened by COGME in April. The first panel explored strategies to “Prepare and Integrate Those Entering the Workforce as New Health Professions Graduates.” Bushardt advocated for a systematic approach to pandemic planning, risk assessment, decision-making, and action, and called for new competencies and assessments “to ensure health professions graduates respond effectively and efficiently during a public health or population-level emergency.” He also called for greater accountability for and pressure by federal regulators on health professions accreditors: “When health professions education accreditation bodies are highly prescriptive and process-oriented (versus outcome-oriented) in their standards, the effect is to hamper innovation and nimble practices that connect training to regional health needs at the educational program level.” He offered examples of PA and medical education programs that have designed and implemented innovative training related to COVID-19 and team-based service activities that create value for their communities. His recommendations included calls for greater “federal and private investment for pilot awards, grant programs, cooperative agreements, and demonstration projects that design, implement, and evaluate effective models for education and workforce development relevant to pandemic response.”

In the final panel, “Assess and Assist Retired Physicians and Other Health Professionals Looking to Re-enter the Workforce,” Bushardt offered recommendations for state and federal regulators and policymakers, including that “state-wide registries of health professionals willing to be called to action during a pandemic or public health emergency” could be paired with policy changes, such as interstate compacts for licensure, and making permanent many of the federal waivers and state executive orders that empower top-of-license practice.” His remarks concluded with examples of workforce re-entry programs that could be expanded to support rapid training, assessment, and workforce readiness for professionals not currently practicing.