PAs Critical to New Mexico Rural Health Clinics

El Centro Family Health Provides Care for 24 Federally Qualified Health Clinics

November 28, 2018

By Eileen Denne, CAE, APR

PAs are central to primary care for families in rural New Mexico and, according to Chief Quality Officer and Medical Director Matthew Probst, PA-C, “PAs strengthen El Centro Family Health’s (ECFH) ability to fulfill its mission.”

As a Federally Qualified Health Clinic (FQHC), ECFH treats 19,000 patients annually at 14 community health centers, nine school-based health centers, and three dental clinics across 23,600 square miles of rural New Mexico. There are 37 medical providers with roughly a third who are physicians, a third PAs, and a third NPs. PAs are at the forefront of patient care and have enhanced ECFH’s ability to improve its organizational goals of service, access, and quality.

Several of those PAs advocated that ECFH apply for the Center for Healthcare Leadership and Management’s (CHLM) Employer of Excellence (EOE) award to recognize it as a unique workplace: “This is an organization that strives to create a workplace balance, as well as to give everyone a voice.”

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ECFH was named a 2018-2019 EOE winner last May. Among the EOE criteria exceeded by ECFH were: establishing a positive and supportive PA work environment; providing opportunities for meaningful input that lead to positive organizational change; and keeping PAs informed and involving PAs in leadership efforts to improve the quality of care.

ECFH was also the subject of a 2018 85-minute documentary film called The Providers, which is described as “featuring several quietly heroic medical professionals who serve a part of the American Southwest almost entirely bereft of medical services. Their patients are poor and struggling—with poverty, with addiction or alcoholism, with old age, chronic illness, parenting. The providers bring enormous patience and skill to the job, which is jeopardized by cutbacks in funding for an outreach program.”¹

Becoming the place for the best healthcare

ECFH’s vision, according to Probst and CEO Lore Pease, “was to become the place that people came to because we were the best at healthcare, not because they couldn’t go anywhere else. The traditional FQHC is a safety net for those who can’t go anywhere else due to transportation or other issues.”

One of ECFH’s challenges was recruiting. Probst says, “All of the evidence was really clear that there was going to be a licensed professional workforce shortage peaking around 2020 with no end in sight. Within that was the PA shortage component, which didn’t help our core model, and also the challenge of being a rural underserved FQHC during that crisis.”

Need for care has shaped how ECFH has evolved. They were very understaffed with physicians and Probst says they were able to address that problem by introducing integrated models of care combining physicians, PAs, and NPs. “With that model, we improved our access to quality of service. We ended up seeing more patients than we ever had before and ended up improving our clinical quality measures.”

Pease likens ECFH’s success to author Jim Collins’ “Good to Great” analogy of getting the right people on the bus and in the right seats. “We were finding PA candidates that were just excellent in their skillset and their personalities that fit our business and community. Here comes a PA with a good CV, good personality, good skills, and we hire them.”

PAs as project leads, clinic teams, preceptors

ECFH PAs serve as leads of specific healthcare projects and local clinic teams, preceptors for future health professionals, mentors for new employees, administrative supervisors, and members of the executive team. As chief quality officer and medical director, Probst says his position “has really empowered me to align our work and our quality manager efforts with what we actually do clinically.”

Pease adds, “There really was a strong need to have Matt in that quality position with his expertise and his knowledge, but also as a FQHC, we have more and more requirements and demands on our quality of work. So, having Matt look at the data and come up with good ideas and processes was critical to our staying on top of what we needed to do for our federally certified healthcare requirements.”

Probst says, “As we see more data for FQHCs, there’s around 40 percent vacancy of licensed staff. At El Centro Family Health, for four years in a row now, we’ve been floating at a 5 percent vacancy rate. So, our positions are way more filled than the average FQHCs.”

More than $1 million in quality awards have gone to ECFH to date. In 2016, ECFH became the first FQHC in New Mexico to achieve AAAHC accredited Patient Centered Medical Home status. It is recognized as a leader in clinical quality measures with multiple HRSA Quality Improvement Grant awards in 2015, 2016, and 2017.

Local recruitment of health professionals

ECFH’s integrated team approach to healthcare fully utilizes the strengths of all health professionals. Data demonstrated it also improved quality of care, patient satisfaction, and employee job satisfaction.

ECFH’s commitment to advancing the PA profession is also evident in the support and enthusiasm it shows to student PAs, who are welcomed for rotations as part of ECFH’s Semillas De Salud, or “Grow Your Own”, Health Professional Program. When New Mexico healthcare academic programs faced a shortage of clinical rotation sites, Probst founded and developed Semillas De Salud. It started as health career clubs in local schools but led to ECFH taking on more students: 368 clinical rotations to health professional students to date. The program now keeps rural and underserved clinics fully staffed despite provider vacancy and has received national attention.

Probst believes the ECFH culture encourages PAs to join the staff: “When they see in El Centro how everyone is valued on the team, that differs a lot from settings they’ve previously worked in other areas. They can find themselves in leadership roles, they can come up with their own projects, not only in administrative leadership roles, but they can lead clinical projects and programs. That’s exciting for them.”

EOE as recruitment tool

ECFH has used the EOE award, says Probst, “internally to empower our staff, to recognize them and for them to feel proud of this award that we’ve all achieved being shoulder-to-shoulder with some of the powerhouses of healthcare in the country.”

Probst further describes the ECFH culture with a saying that, ‘you can judge a society by how they treat their most marginalized.’ “Look at what we do for patients and how we treat everyone as an individual, regardless of their background or economic situation or their insurance status. That same culture, that same philosophy, also applies to how we do things in leadership and management and staffing. By keeping humanity in healthcare we end up just being a big work family and our patients are part of that family and everyone’s valued. El Centro Family Health is our name, but it’s really who we are.”

It was important for ECFH to apply for the EOE award, according to Probst, because, “We’re great and we’ve been great. Along with quality data, the EOE award allowed us to say we’re an excellent employer. We employ excellence.”

ECFH plans to re-apply for the EOE award in 2020 to take advantage of the opportunity to be recognized as a great place for PAs to work.

Apply for Employer of Excellence Award

The EOE Awards are designed to recognize and showcase employers that create a PA-positive environment and encourage collaborative provider teams. CHLM partnered with HealthStream in 2017 to better understand what PAs value in their place of employment. Based on the findings, CHLM identified five key drivers as criteria for its EOE Awards, including:

• Establishing a positive and supportive PA work environment.
• Providing opportunities for PAs to provide meaningful input that leads to positive organizational change.
• Keeping PAs informed of organizational activity and decisions.
• Involving PAs in leadership efforts to improve the quality of patient care.
• Creating processes for effective conflict management.

Applications for 2019-2020 EOE Awards are open through Feb. 8. CHLM works directly with hospitals and health systems to enhance team-based patient care and optimize PA practice.

1 Augderheide, P. Trumpeting Decency in Trump’s Town: AFI Docs Showcases Big Issues. International Documentary Association. Accessed Nov. 11, 2018.

Eileen Denne is director of Corporate Communications at AAPA. Contact her at [email protected].