When physician assistant Laura Alison works her last shift at Community Health Services of Union County later this month, she’ll walk away not only having helped improve the health of hundreds of patients, but having helped prepare scores of new PAs to do the same.
A Wingate University employee embedded at the free clinic since 2017, Alison has helped transform its mission from mainly diabetes management to full-fledged primary care for uninsured Union and Anson county residents.
The Iowa native and 2015 Des Moines University grad will move back to her home state with an even greater commitment to community health.
“It gives me hope that I could be part of another clinic like this. That is why I got into medicine: to help improve access to care,” Alison says. “This clinic has definitely been a blessing in my life. It’s so rewarding to work with these patients and learn from them.”
Alison came to North Carolina as part of the National Health Service Corps and worked in community health in Concord for two years before answering Wingate’s ad for a PA to expand care at CHSUC and supervise health science students headed to the Monroe facility for clinicals.
The job was right up her alley, considering that she had just come out of PA school two years earlier with her own clinical rotations still top of mind. She remembered clearly what it was like to be a student and how much she learned by doing, rather than just watching.
“I utilized the student as another provider, because giving them autonomy really helps increase confidence in their own decision-making,” she says. “I let them do a lot.”
Remembering preceptors who took time to mentor her but also pushed her to confidently apply her knowledge, even when she was uncomfortable doing so, Alison led Wingate PA students through just a half-day of shadowing before having them see patients on their own, report their findings and create treatment plans. They would also review lab reports and discuss with Alison how they planned to inform patients about their results.
That follow-up component – hearing lab results straight from the healthcare provider who ordered the tests – is atypical in many healthcare settings today, but it is one of several ways Alison says the clinic offers quality, personalized care.
Additionally, appointments are not overly rushed, and onsite interpreters help ensure accurate patient-doctor communication. Up to four-fifths of patients at the clinic speak primarily Spanish. Filtering the information through an interpreter might take time, but the clinic’s mission is to provide the best care possible, and longer appointments ultimately lead to better outcomes.
“It may take longer to get the information, but our schedule allows us to spend time with our patients, similar to the way medicine used to be,” Alison says. “Rather than rush them through, we can spend enough time to really get issues addressed. That’s been a huge blessing to our patients.”
The clinic environment also benefits students. For one thing, it gives them experience using an interpreter and working with underserved populations. Just as important, they get real-world experience.
“It is really hands-on, with not a lot of diagnostic tests, so students get practice thinking through care plans in the most affordable way possible,” Alison says.
And again, she emphasizes the autonomy afforded them at the clinic, where they are supervised but not micromanaged.
Doing the job she signed up for
On a typical day at CHSUC, alongside a PA student working a five-week clinical rotation will be Wingate pharmacy students, nursing students and those studying medical interpreting, all putting their knowledge to work serving patients and soaking in what it takes to make a community clinic successful.
“This clinic is the perfect spot for students to continue to do their rotations. It has been a really good experience,” Alison says. “When I was in PA school, I rotated on Indian reservations and in other rural underserved communities. In those settings there are a lot of opportunities to make a difference in the lives of the patients, and also learn how to problem solve, which tremendously helps you in your career.”
Alison sings the praises of support staff, many of whom have been with CHSUC for years. She says their willingness to go above and beyond as the one-time diabetes clinic morphed into a primary-care office was essential to meeting patient needs, which often involves referrals to specialists.
She says they know the patients well and do a great job of communicating patient needs. They’ve also been willing to give more of their time and energy to patients, she says.
That commitment has been especially important during the Covid-19 pandemic, when the clinic at first shifted to an 85-percent virtual schedule. The staff switched all patients to virtual visits unless Alison deemed it necessary that they be seen in person. Many medical offices closed during this time, but Alison knew she needed to keep the clinic running in order to prevent emergency rooms and urgent cares from being flooded.
To keep operating, the clinic delayed preventive care and handled most other cases virtually for about three months until it became necessary to start seeing patients in person. They closed the waiting room, instead doing car visits for patients with respiratory complaints.
“It was pretty hot being all gowned up in the summer,” Alison says, “but we didn’t want to send the patients to an already full ER where they could potentially be further exposed to Covid-19.”
The clinic did everything possible to take pressure off the hospital system as Covid case counts mounted. By the New Year, CHSUC had transitioned back to all in-person appointments, with the exception of its highest-risk patients.
“Of course we wear PPE and take temperatures and all that, but we really needed to get back to in-person to resume high quality health care,” Alison says. “Some clinics are relying on virtual, but patients are getting missed, and things are getting delayed to the point that they can’t get delayed anymore in my opinion.”
Initially, Wingate health science students shifted to online clinicals for a month or two, but they have been back working inside the clinic for the past three to four months. CHSUC took pains to keep students out of exam rooms if Covid was suspected. And PA candidates now review their lab reports with Alison remotely each Friday.
Personally, she has taken the pandemic in stride, trying to make reasonable decisions and not feed into fear.
“I think back to when I worked in the hospital as a tech. There were people I had to be up close with that had all kinds of diseases. I didn’t think twice about gowning up, because people need care,” Alison says. “With Covid, there was so much fear behind it. It was hard to balance what you are seeing on the news and outside of work. It was when I was at the clinic that I felt most normal. No matter what the patient had, we saw them regardless.
“Do I look forward to the days when we don’t have to wear a mask all day? Yes! But overall, day to day, there’s not that big a difference. We need to do our job. That’s what I signed up for.”
March 15, 2021