February 20, 2020
PA Devotes Career to Treating At-Risk Populations
Debbie Newman Promotes Buprenorphine Waiver Training for All PAs
June 29, 2018
By Kate Maloney
“Ever since I was a little girl,” Debbie Newman, PA-C, says, “I knew I wanted to go into medicine.” Newman grew up in Philadelphia, Pennsylvania, and graduated from Pennsylvania State University with a degree in science writing. She then returned to Philadelphia and got her graduate degree in public health from Temple University. She stayed in the city and worked as a product manager for a large, international pharmaceutical company in their pediatric products division. When her children were born, she segued to contract work, writing physician and patient educational materials for a variety of pharmaceutical companies. But when her family moved to New Mexico in 1994, she wanted to work in public health for the state government and found it impossible to get her foot in the door. Committed to community health education, Newman found public health related jobs in Santa Fe County: assisting in the start-up of Early Head Start programs and education and awareness programs at local hospitals and communities. But after some time, she felt she wanted to move on with her career, and work directly with patients.
“It was always gnawing at me,” she shares. “I knew I could do more, I wanted to do more, and I reached a point where I needed to do more.” The PA career had always interested her – it would combine her passions for healthcare and education. Despite hearing that PA school was not easy for a parent with school-age children at home, Newman enrolled at the University of St. Francis. Her path to graduation was even more arduous than other PAs’; she needed to retake many of the prerequisites, and this took over a year of study. She admits she doubted herself every day. “My friends were just shocked,” she laughs. “’This is your third career, your third degree!’ they’d joke.” Luckily, Newman had a supportive family and a goal to achieve. “It had been a lifelong dream of mine to pursue a career in medicine.”
Newman completed PA school in 2007. She soon found a position 30 miles north of Santa Fe, in Rio Arriba county, known for its long-standing history of heroin use and overdose deaths, and high rates of Hepatitis C. Newman, who had spent her life working in public health, was eager to help such an at-need community.
The position in Rio Arriba was a perfect intersection of her work in public health and her PA career. She was helping a high-need population with few providers, and she was “able to take extra time to make a difference in patient care.” She recalled seeing one patient with opioid use and cocaine use disorders, who continued to relapse, likely due to co-occurring disorders.. Newman was committed to figuring out a treatment plan that would work for this patient; she suspected that there was an underlying mental health issue, and asked the clinic’s addiction medicine psychiatrist to evaluate him. Newman was right, and she’d identified something that the patient’s family care provider had missed. Working with the psychiatrist, Newman was able to get the patient into the psychiatrist’s private clinic, where they were able to develop a treatment plan that is still working today. The patient is now stable and drug-free. Newman attributes this success story to PAs taking additional patient time: “I think about that patient, and what would have happened to him otherwise…” Newman trails off. “It could have tipped the wrong way in heartbeat.”
While in Rio Arriba, Newman also became involved in telemedicine. The University of New Mexico, through Project ECHO, helped subsidize her position there as a Community Health Extension Agent (CHEA), and required that she participate in a Hepatitis C telemedicine clinic. She was able to choose two other telemedicine clinics in which to participate, and she chose chronic pain and headache treatment, and integrated addiction and psychiatry. Three days a week, she would attend these telemedicine clinics. They each began with 30 minutes of a didactic presentation, then transitioned to discussing individual cases.
Newman explains that “a provider like me could complete a template with your main question about this patient, including – past medical history, medications, therapies, on and on, and then you’d have five or 10 minutes to present the case to everyone who is on audio or video that day.” People from all over the country would contribute their thoughts and providers like Newman would leave the telemedicine clinic with a treatment plan for their patient. In a rural location like Rio Arriba, the telemedicine clinics were invaluable. Newman was able to collaborate with many more healthcare providers than if she’d been limited by geography.
After practicing in Rio Arriba for four years, Newman found herself emotionally taxed and physically exhausted. While she knew she could no longer work in Rio Arriba full time, she also knew that she was “extraordinarily passionate” about addiction medicine and wanted to continue practicing in that field. “I think a lot of people are afraid of this patient population,” she says. “But if you ask a roomful of people how many of them have had a friend, or neighbor, or loved one who’s been impacted by a substance-use disorder, I would bet that 80 percent or more would raise their hands.”
Newman has since devoted her PA career to addiction medicine. She still practices in Rio Arriba one day a month through her work as a treatment provider with First Judicial District Court’s Adult Drug Court, and also works part time at a Kaiser Permanente facility in Denver, Colorado in Chemical Dependency and Treatment Services. She spends one day a week in Santa Fe’s drug court, where she provides medication-assisted treatment, evaluates clients, and recommends courses of treatment. “The vast majority of clients in drug court have significant trauma,” she says. “And they have only ever been treated in jail.” The adult drug court provides counseling, mindfulness meditation, and other modalities to help treat clients struggling with substance use disorders, including alcohol, opioids, stimulants, etc. PAs like Newman are advocating for more patient-focused solutions to substance-use disorders: medication-assisted treatment like buprenorphine, methadone, and when appropriate, naltrexone.
Newman vehemently promotes that all PAs complete buprenorphine waiver training and apply for their waivers. She wonders: “If we are going to be sending people out [of the emergency room] with an opioid prescription for whatever their pain complaint might be, then why can’t we send people who come in with an opioid use disorder out with a buprenorphine prescription?”
AAPA, ASAM, and AANP have formed a collaborative to provide the 24-hour waiver training to satisfy the requirements for PAs as described in the Comprehensive Addiction and Recovery Act (CARA). Follow in Newman’s footsteps, and start your own buprenorphine waiver training today.
Kate Maloney is AAPA’s senior manager, corporate communications. Contact her at [email protected].