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Pulse Magazine Winter 99 Issue

In this issue...

From The Editor

Generation Next

Alumni Perspective

Prescription Filled

Shining Stars

The Last Word: Health Care and The Graying

of Small Town Texas

FROM THE EDITOR... New Look, Same Objective By Kent Best

Depending on whose math you choose to believe, this is either the last Pulse of the millennium, or simply the last one of the 1990s. Either way, this edition of the magazine is significant for at least two reasons. First, it's largely devoted to what is sure to be one of the fundamental health issues of the 21st century - aging - and second, it looks different.

The newly designed Pulse is part of Texas Tech University Health Sciences Center's outreach to our extended family of alumni and friends - who now reside in all 50 states and 12 countries - and we hope you find it pleasing and informative. Special thanks to designer Pat Maines for incorporating a new look while maintaining the best traits of the previous issues.

Within these pages, you'll find a redesigned class notes section, with coverage of the fall reunions, and a new profile segment that highlights a key supporter of the university. The first installment features Betsy Triplett-Hurt, a long-time friend of Texas Tech in the Permian Basin.

Among the feature stories, please take time to read Amarillo staff writer Rana McDonald's piece on the new pharmacy museum in Amarillo and Odessa free-lancer Lana Cunningham Cooper's story on the new physician assistant program in Midland. Both stories are interesting reads and are accompanied by Artie Limmer's photography. The "Little Voice" story, by our summer intern Sally Smith with photography by Melissa Goodlett, is another feature that deserves a look.

How does it feel?

In the late 1970s, comedian Richard Belzer frequently did a parody of Bob Dylan's "Like a Rolling Stone" on the comedy club circuit, changing the lyrics to "Like a Rolling Gallstone" in reference to the musician's advancing years.

Twenty years later Belzer has stopped poking fun at middle-aged musicians, choosing instead to play a middle-aged cop on television. With many of Belzer's generation now older than their parents were in the '60s, the gallstone jokes are no longer so funny. Talk about your Wonder Years, most Baby Boomers probably wonder where the years went.

At least they're not alone. Estimates are that the number of Americans over 65 will double within the next 30 years.

Against this backdrop, Texas Tech University Health Sciences Center is moving rapidly to develop a comprehensive geriatrics program to deal with the coming elderly wave.

The first stage of this initiative is a long-term care center built in partnership with Sears Methodist Retirement Systems Inc. of Abilene. This unique facility will feature a blend of care, education and research that will serve a two-fold purpose. First, the center will provide the best possible long-term care to its residents. Second, a new generation of health care providers will be taught how to treat the elderly, both as patients and as valuable members of society.

Texas Tech owes a debt of thanks to Sears Methodist, which will make a substantial investment in this project, and to Sen. Kay Bailey Hutchison and Reps. Larry Combest and Henry Bonilla, whose roles in securing funding bolster Tech's long-range commitment to becoming a national leader in the field of geriatrics.

"President David Smith and the faculty at Texas Tech University Health Sciences Center have established aging research, education and care as priorities," says Chancellor John T. Montford. "This funding will allow that program to expand its activities and accelerate our ability to produce results that can help improve the health and well being of senior citizens everywhere."

Even Richard Belzer, with or without gallstones, could see that's no joke.

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GENERATION NEXT: Baby Boomers are about to boom again, and Texas Tech plans to be ready for the coming elderly wave.
By Kent Best

The stretch of road between the tiny farming community of New Home and Lubbock is 15 miles long. There are four good-sized curves on the route, a couple of grape orchards, acres of cotton and maize, a church and a rodeo arena.

My 79-year-old mother lives just about two miles east of New Home, and for 20 years I have navigated the modest distance from Lubbock to her house. Over the years the trips have been for grocery deliveries, lawn-mowing jobs, gardening chores, Sunday dinners and holidays.

Increasingly, the trips also have been to help my mom deal with growing old.

My father, a retired oilfield supply store manager, died a little more than two years ago of congestive heart failure. Since that time, my mother has been hospitalized with a broken hip, a stomach ailment and asthma. She is remarkably resilient and has recovered from each setback.

But with each passing year, the odds are stacked against her and the other Americans now over the age of 65. The term Golden Years may have a nice ring to it, but for many older Americans, the phrase rings hollow.

"You hope to grow old gracefully, but it doesn't always work out that way," my mom says.

At my mother's birth, there were fewer than 5 million Americans over the age of 65. Since then, the number of Americans in that age group has increased to 34 million. And that number is growing exponentially. In another 30 years, it is estimated that 70 million Americans will be past retirement age.

With such growing numbers, it is clear that our youth-obsessed culture will need an attitude adjustment. Make way, Generation X; here comes Generation Next.

"The demographics show that there will be an enormous population needing care," says Richard Homan, M.D., chairman of the Texas Tech Department of Family and Community Medicine who is board certified in family practice, geriatric medicine and sports medicine. "We have to address the elderly more explicitly in the curriculum rather than have it as an afterthought."

As a cardiologist for more than 20 years, Texas Tech School of Medicine Dean Joel Kupersmith, M.D., has watched the aging of America with particular interest. To him, the demographics show that a physician's practice is going to be increasingly geared to the elderly - out of necessity. "One of the things that we have to be concerned about in medical education is to make sure that we are training physicians - whether they be generalists or surgeons or cardiologists -in the care of elderly, and also that we train people in the field of geriatrics."

Of the nation's 128 medical schools, only 14 offer formal training in geriatrics and only 3 percent of students say they are interested in the field. Here's the offshoot: Only 8,000 of the nation's 700,000 physicians specialize in geriatrics. Adding urgency to an already dire situation is that the "new" old likely will be a demanding bunch, the days of slowly rusting away in the front porch rocker going the way of dime stores and the drive-in movie. Consider, for example, rock 'n' roller Neil Young, who once admonished Boomers that it is better to burn out than it is to rust. Despite his and his generation's best attempts, Young, who remains a significant musical presence well into his 50s, appears to have neither burned out nor rusted away.

"There will be a large pool of talent that is going to expect to remain a vital part of society, both as an experienced workforce and as volunteers," Homan says of today's 50-somethings. "Our elderly have great potential as a resource, but also as a potential financial liability. As the population gets older, the rate of usage of medical services increases. Our hope is to keep patients functional for as long as possible so that they can be as productive as they want to be."

Randolph Schiffer, M.D., chair of the Department of Neuropsychiatry at Texas Tech University Health Sciences Center, says that even with the American culture's longstanding appreciation of youth, more is expected of those over 50, 60 and even 70 - provided they remain healthy.

"Just look at our leaders," he says. "Our presidents, senators, heads of corporations, heads of universities - they're all typically older, in many cases much older. We're not all that comfortable with anybody under the age of 40 or even 45 for those jobs. So although we still have a lot of age bias in this country, we have some very positive views of aging, too. We still think older people are wiser. We think older people make better choices. We think they listen better. We think they have the ability to control their impulses better."

If, as Homan suggests, health care currently is ill-equipped to face the aging challenge, it's worth considering how many potential leaders might be prematurely lost to chronic illness - especially dementia-related diseases such as Alzheimer's - or something less mysterious, like a broken hip.

"We think we have drugs and genetic tests right now that will enable us to identify people at risk and postpone the onset of Alzheimer's disease," Schiffer says. "But we're not diagnosing and treating many of these people because we have not had a system to deliver these treatments. In West Texas alone, we think that maybe 70 to 80 percent of the people who have Alzheimer's disease are not diagnosed."

One of the major shortcomings in health care can be found in one of the fastest growing segments of the U.S. population: the "oldest old," people over the age of 85 who require specialized care. In my family alone, one great aunt is 102, another aunt is 91. The 102-year-old still lives at home with the assistance of home health, while the other suffers from dementia and lives in a nursing home facility. This from a generation born when the average life expectancy was less than 50 years. Imagine the number of 91-year-olds in the middle of the next century when the Baby Boomers, now in their 40s and 50s, reach the end of their first century. It's clear that health care's job, already tough, is about to get a whole lot tougher.

"With a larger and larger elderly population there will be more chronic disease, which will require more from health care," Homan says.

Dementia, arthritis, visual loss and hearing loss are called the four horsemen of the apocalypse for America's elderly by Schiffer, who is acutely aware of the problems associated with Alzheimer's disease, a scourge of the elderly and near elderly that Schiffer says is inextricably intertwined with aging. Statistics back him up - 4 million U.S. residents currently are afflicted with Alzheimer's, the preponderance of those with the disease at the highest ages. The number of Alzheimer's-diagnosed elderly is expected to balloon to 14 million by the middle of the next century.

"For me the problem of the aging of the U.S. population and the problem of

Alzheimer's disease are inseparable," Schiffer says. "The other problems are significant, but Alzheimer's disease is way out front as a major problem."

In 1999, the annual direct and indirect costs associated with care for Americans with Alzheimer's disease was between $90 billion and $100 billion. Schiffer offers the sobering theory that Alzheimer's may actually be a disease that everyone eventually gets - providing they live long enough. "I don't think we have any other disease like that, except for maybe arthritis," he says.

Against this rather bleak backdrop, Texas Tech University Health Sciences Center recently unveiled a plan to become a national leader in caring for the aged. The first component in this shift to a more age-related health care paradigm - the result of a partnership between the university and a private company, Sears Methodist Retirement System, Inc., of Abilene - is a new geriatric long-term care and teaching center, the first facility of its kind in the nation.

The 66,000-square-foot facility will be located on eight acres just north of the Health Sciences Center and will cost about $10 million to construct. The facility will include 120 beds, 60 dedicated to Alzheimer's care and 60 dedicated to traditional nursing care. The center also will contain classrooms, expanded nurses stations to accommodate students, faculty and student offices, observational facilities and rooms wired for telemedicine use. Texas Tech and Sears Methodist expect groundbreaking for the facility to occur this summer.

"Sears Methodist was selected for this project because of their outstanding reputation in the field of geriatric care," says TTUHSC President David R. Smith, M.D. "This facility will be the first of its kind that will be both located on the campus of an academic health center and designed in cooperation with the academic health center faculty. Just as many of the most important medical breakthroughs have come out of our nation's teaching hospitals, we believe that similar breakthroughs in care for the elderly can come from this facility."

For most people, a long-term care facility, no matter how advanced, is not seen as an ideal retirement destination. For most, the goal is to remain at home for as long as possible. But for some, especially those with dementia-related diseases, living an independent life in the family home is not a viable option.

"The ideal form of aging is squaring the disability curve," Randolph Schiffer says. "Many people gradually accumulate disabilities over the years and then they die. What we want is to have a flat line where they don't accumulate disability and then all of a sudden they die. So ideally, they don't go to the nursing home. Of course that's the ideal. In reality it doesn't work that way - there will always be people who need long-term care."

Keith Perry, chief executive officer of Sears Methodist Retirement Systems, says one of the goals of the new center is to help those elderly people who can no longer remain at home live in the next best thing - an unconventional nursing home that is different from any previously built.

"Designing a facility that doesn't look like an institution is critical," he says. "It must be one that meets the needs of the people who live there, while also accommodating the divergent interests of the students and faculty who learn and practice there."

Besides the physical appearance of the building, the center will be different in some other fundamental ways.

Perhaps the most significant difference will be in the way the center is staffed. Faculty from each of the Texas Tech Health Sciences Center's schools will play key roles in the care of the center's residents. Additionally, students from the schools of Allied Health, Medicine, Nursing and Pharmacy will be educated and provide care in a real-world geriatric facility.

Such across-the-board teamwork will be one of the hallmarks of the new center, says Cynthia Raehl, Pharm.D., chair of the Texas Tech School of Pharmacy's Department of Pharmacy Practice.

"Students from diverse areas such as recreational therapy, education, law and the clergy will be included in the multidisciplinary teams," she says. "We'll also make special efforts to attract local junior and high school programs into local- and nursing home-based educational programs to encourage young people to seek careers in helping to care for the elderly."

Raehl adds that continuing education of local health care workers, including primary care physicians, clinic nurses, community pharmacists and nursing home staff, will be emphasized using both telemedicine and hands-on training programs.

Raymond Linville, Ph.D., chair of the Department of Communication Disorders, says Sears Methodist has a reputation for building facilities that are not just for the terminally ill.

"Their facilities are well organized and expertly designed for a variety of residents," he says. "Allied Health students will be afforded one-of-a-kind opportunities to work with physicians, medical and pharmacy residents and nursing students, as well as a wide variety of related professionals from the Texas Tech University campus. These experiences will not only make them highly marketable in terms of employment, but set a new standard for educating students to work with the elderly."

Ike and Annie White, who have lived in Lubbock since the 1920s, are fairly typical West Texans. They have a strong feel for the history of the area and an even stronger bond to the present. "There's a special sense of history in this part of the world," Annie White says proudly.

A retired businessman and gas company engineer, 81-year-old Ike still drives a pickup for daily errands and tends to the couple's yard with more enthusiasm than the average 30-year-old. Until she fell and broke her hip two years ago, the 77-year-old Annie was still tending to the needs of her older friends and remains an avid historian.

Since her fall, Annie's pace has slowed. She and Ike also have begun to think more about their future.

"Our biggest concern is who's going to take care of us when we are unable to take care of ourselves," Annie says. "We have two sons, but they can't quit their jobs and move here to take care of us. And we wouldn't want them to."

"We want to know that we will continue to have a source for treatment so that we can live a life with some quality," says Ike. "We're not interested in just breathing, we want to enjoy life."

For people like my mother and the Whites, the uncertainties of growing older are compounded by the certainties of existing health problems. Asthma and arthritis are daily issues for my mom, while for the Whites, health problems include a broken hip and diabetes. Annie also has dealt with heart and stomach problems, while Ike has undergone two heart bypass surgeries, recurring skin cancer and an artificial right knee.

"When I broke my hip I began to feel old for the first time," Annie says. "I didn't realize that I was a senior citizen until I broke my hip."

The Whites say proximity to expert health care is one of the primary reasons that they are still at home. Their well-kept residence in central Lubbock is about five minutes by car from University Medical Center and Richard Homan, their family doctor.

"The vast majority of patients 65 and older are still at home, functioning the best they can," says Homan. "Ike and Annie are a perfect example of that. They are doing well with ambulatory care. Not everyone that age is in a nursing home setting. Our job will be to develop strategies to improve access to care so that those people who don't require long-term care can remain at home."

One of the goals for the new facility is to develop a database of people - like the Whites - who are still living at home with chronic medical conditions. The focus for this aspect of the center will be on preventive care and chronic-care training for patients, their families and the students who are educated there.

"The problems our aging population present to the medical community are vast and growing, but what may be even more problematic is the relatively small number of advanced trained professionals within the field of geriatrics who care for this population's needs," says Rebecca Sleeper, an assistant professor of Pharmacy Practice in Geriatrics and the primary School of Pharmacy faculty member to be on staff at the center.

"Texas Tech is in a prime position to disseminate expertise in this area," Sleeper says. "This is especially valuable in an environment such as West Texas."

According to TTUHSC Lubbock campus service area demographics, nearly one-third of the 2.55 million Texans in the area TTUHSC serves live in rural communities and may have limited health care access. A disproportionate percentage of these residents are older adults. As compared to urban areas, nearly twice as many rural Texans are over the age of 65.

Ana Valadez, R.N., Ed.D., CNAA, FAAN, director of the School of Nursing's undergraduate program and professor in the Roberts' Practiceship, says the new facility will have tremendous potential to serve these rural West Texans. "The nursing faculty and students can contribute toward quality care for the elderly by designing protocols that address care from the perspective of what is best for the nursing home resident and how they can help to deliver optimum, quality care," Valadez says. "Nursing students will have the opportunity to work with other health care professionals that also ascribe to caring, sensitive care for the nursing home residents."

"Our goal is to create teams that are efficient and caring to bring elderly care to a new level," says Joel Kupersmith. "We also want to do some cutting-edge research in aging - basic science, clinical and outcomes research - to determine the best way to care for elderly patients."

Raymond Linville adds that the new facility will advance patient care while also containing its overall costs. "I envision improved efficiency as a result of each team member becoming more aware of the other team members' treatment philosophies, goals and objectives," he says.

Residents of nursing homes far from Lubbock also could benefit from such all-for-one philosophy via HealthNet interactive video, Sleeper says.

"Interdisciplinary systems of care can serve as models of patient care for other facilities, both within Texas and nationally," she says. "The emphasis and priority which Texas Tech has placed on healthy aging and geriatric care is so important. Competent health professionals with geriatric expertise from each of the schools within the Texas Tech University Health Sciences Center will likely become valued and sought after caregivers as the demands of the aging population increase."

Linville concurs, saying that Texas Tech has an opportunity to address a growing need for health-care professionals with the requisite knowledge and experiences necessary to work with older patients.

"Many graduates have traditionally preferred to work with other patient populations they perceived as being more glamorous," he says. "For some, the idea of working in a long-term care facility is less appealing than working in a modern, tertiary medical facility, especially if it's located in a popular and better-paying metropolitan area. Second, young or beginning professionals sometimes perceive nursing homes as being depressing and occupied only by the terminally ill. Often this is based upon a vivid personal memory of a grandparent who died in a nursing home. Our partnership will change this."

Sears Methodist's Keith Perry says it's all about having the vision to address a need and meet it head on. "Here is a case where a public and private partnership is going to work toward a solution."

Back home with my mother, I listen as she hands me a bottle of medicine to open. "I wore myself out trying to get that lid off this morning," she says as I complete the push-and-turn procedure and hand her the open container. "It's amazing that something like that can affect my entire day."

My mom is a resourceful woman. Growing up during the Great Depression seems to have instilled in her generation more grit than most. But as I survey the half-dozen or so medicine bottles opened on previous visits, their pre-loosened tops perched lightly atop each one, I realize that even resourcefulness has its limits.

"I think security and piece of mind are what most of us are after," she says as she counts out a week's worth of arthritis medication for her daily pill-minder. "As you get older, you begin to feel more insecure about things. You become more dependent on others and you feel more vulnerable."

Over the last 20 years I have witnessed firsthand the increased dependence, the increased vulnerability of first my dad, and now my mother. But unlike the road to New Home, there are no definite road maps for aging - only the hope that the road ahead will be smooth and he shoulders wide.

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ALUMNI PERSPECTIVE

Loss of income, loss of family and loss of health are the fundamental issues facing older West Texans, say Texas Tech School of Nursing alumni Deb McCollough and Peggy Thurston.

McCollough and Thurston are family nurse practitioners in Andrews, about 35 miles north of Odessa. McCollough (BSN '87, MSN, '93) is the clinic director for the Andrews County Health Department and Thurston (MSN '98) works as the health department's nursing director.

The health department provides health care to the uninsured working poor in Andrews County, but it also provides a safety net for the elderly. Because of the financial status of many of the department's patients, keeping that safety net intact is often difficult.

"Sometimes we make a diagnosis and order a treatment, but the person can't afford that treatment," McCollough says.

McCollough and Thurston both agree that the major aging issue facing the elderly is the cost of prescription medications. "Many of these people are on multiple medications and on fixed incomes and can't afford the prescriptions," McCollough says.

"And Medicare, which covers their medical bills, doesn't cover the cost of their medicines. That is a big problem," Thurston says.

Isolation from family also is a financial burden on the elderly, they say. "With the mobile society that we have, the elderly don't have their extended family close by to help in times of medical crisis. That creates more expensive options like nursing homes and assisted living centers," McCollough says. "In our population here in Andrews County, most people can't afford either of those."

Thurston says proximity to specialized care is another issue for the rural elderly and even those in a town such as Andrews, which has a population of about 10,000. "If an elderly person needs specialized care it may mean getting to a larger city, such as Lubbock or Midland. If you're elderly that can be very difficult, especially if you don't have a spouse or other family member to drive."

McCollough, who is from Manitoba, Canada, and Thurston, who grew up in Denver City, agree that these aging issues are not unique to Andrews.

"You would find these same problems in any other rural area," McCollough says.

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PRESCRIPTION FILLED - Texas Pharmacy Museum first in the Lone Star State
By Rana McDonald

AMARILLO - The Texas Tech School of Pharmacy at Amarillo epitomizes the high-tech, computerized world of today's pharmacy education. But tucked inside its brick walls, between its computer-based classrooms and research laboratories, a museum offers a glimpse into pharmacy's past.

The Texas Pharmacy Museum, housed in the Texas Tech School of Pharmacy at Amarillo, is the first museum of its kind in the state of Texas and the first museum/laboratory for pharmacy students. More than $800,000 worth of antiques from Texas to California has been committed to the five-room museum from private collections. These pieces trace the history and recreate the story of pharmacy since 1860 in four major areas.

"The museum is a resource students can use while learning about the high-tech world of modern pharmacy," said Arthur A. Nelson, Jr., dean of the Texas Tech School of Pharmacy. "The students can come to the museum and discover the roots of their profession."

After students complete lecture assignments on lap top computers, they can walk through the museum and discover the world of pharmacy before technology was a part of the profession. Artifacts ranging from show globes to pill-making tools are just a few of the items housed in the museum.

One section of the museum is devoted to the drug store of the early 1930s. The room houses the complete furnishings of an old-time drug store where the pharmacist diagnosed, prescribed and counseled. Shelves and display cases are stocked with medicines and merchandise of that era. A jeweler's repair counter and a post office window complete the look of this early drug store.

The museum's Pioneer Hall honors retired or deceased pharmacists who practiced in Texas. Descendants can tour the room and discover the names of each honored pharmacist, where he or she practiced and when.

Visitors and students alike can also see an array of pictorials, old advertisements and paintings that depict the day-to-day life of the community pharmacy from its earliest beginnings. Other exhibits include an extensive collection of injectable products and the only collection of early products related to women prior to 1950.

The museum first began as a dream of Billy Walker (Texas Tech '57), a retired drug representative from San Antonio. Walker became an avid collector of pharmacy antiques and memorabilia more than 30 years ago. When he retired from his job as a drug representative, he became involved in the Texas Pharmacy Association. The association gave him the opportunity to work under the Texas Pharmacy Foundation and before long, his collection grew from a few bottles and jars to include everything from books and art to scales and cabinets.

"I started buying more and travelling all over Texas," Walker said. "All of a sudden I found myself with full sets of cabinets and more artifacts than I could possibly ever use. That's when I began dreaming of a museum."

In August, 1996, he pitched the idea of a pharmacy museum to deans, pharmacy leaders and development people. But no one was willing to take on the project. "I was just crushed," he said. Then in July 1997, he met with Nelson. The two men spent the day talking and looking through Walker's warehouses and storage buildings full of pharmacy antiques. From there, Nelson drove to Austin to meet with the deans of the University of Houston, Texas Southern University and the University of Texas and told them, "I'm going to build that museum."

The Texas Pharmacy Museum is a dream come true for Walker. He serves as the museum's founding curator and the facility houses his extensive collection of old-time pharmacy bottles, tools and furnishings. "There's not another story in the United States told like this," Walker says of the museum. And that story tells of a time before computers, when pharmacists used manual typewriters or kept records by hand.

"Students think computers have been around forever," he says. "They don't know that pharmacists used to make pills, suppositories, solutions and ointments. Students need to know this, their roots, so they can appreciate pharmacy. That's the story this museum tells."

The Texas Pharmacy Museum, part of the Texas Tech School of Pharmacy, is located at 1300 Coulter in Amarillo. For more information, call the Texas Tech School of Pharmacy at 806-354-5463.

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SHINING STARS - New Physician Assistant Program welcomes its first class By Lana Cunningham Cooper

MIDLAND - They came from various walks of life - one was an oilfield executive, another was studying biology and working in a doctor's office. But this summer 16 students had one thing in common as the inaugural class of the Physician Assistant Program huddled in a classroom for the start of what will ultimately be 27 months of intensive education.

Orientation began the first week of June and classes started June 7. In August 2001, graduates of the program will be ready to team with physicians to provide better medical services to rural Texans.

The program initiates a unique partnership between Texas Tech University Health Sciences Center and Midland College. The new PA program will be housed in a building on the Midland College campus that will be owned by the two institutions. Meanwhile, the baccalaureate program falls under the auspices of Texas Tech.

"The concept is to meet the health care needs of West Texas," says Michael Clark, PA-C, Ph.D., program director. "The rural areas are underserved. Our core curriculum is designed around primary care medicine," which covers the gamut of problems a physician assistant might face in a small town many miles from the nearest city.

Robin Satterwhite, regional dean of the TTUHSC School of Allied Health, says he is enthusiastic about the potential for the new program.

"One of our primary missions is to serve the rural health care market," he says. "The Physician Assistant program will make tremendous strides in fulfilling that mission by filling a niche in rural areas. Physician assistants are the health care providers when physicians are absent."

A physician assistant becomes an extension of the physician's practice. The PA may take medical histories, perform physical exams, order and interpret diagnostic tests, formulate a working diagnosis and implement a treatment plan. "The PA can be utilized by physicians to see routine cases while a physician sees patients with complex problems," Clark explains.

Physician assistants can serve in any health care setting, Satterwhite says. This includes small hospital emergency rooms and nursing homes. After having worked as an administrator of a rural hospital, Satterwhite says he knows the expense of hiring an emergency room physician cannot always be justified. But PAs often can fill the bill.

The idea for a physician assistant program dates back to the mid-1960s when there was a perception of a shortage of physicians, Clark explains. "The first students were combat medics who had gained a lot of experience in war but had no civilian equivalency," he says. "The program has evolved tremendously since then."

The average PA student is older, usually around 29 or 30, and has some experience in health care. "People with a health care background acclimate a lot more quickly to the intensity of the program," Clark says. "A lot of PA students have been nurses, lab specialists, dietitians and pharmacists." Ages in the current class run from 24 to 47.

The accountant who once worked for an oilfield company is one of the older students in the class. "This man had other things he wanted to accomplish with his life, and he had gone back to school a couple of years ago for undergraduate work in pre-medical sciences. That is a prerequisite for the PA program," Clark says. "This student said he wanted to do something in the medical field, and the PA program fit the bill. He liked what PAs do and their relationship with physicians."

After the three-day orientation this summer, student Sarah Shanks said she was eager to start classes. She was studying biology and working in a doctor's office when she heard about the Texas Tech Physician Assistant program. She applied and was among the 16 students accepted from 110 applications.

"I want to do something in the medical field, and with this program I can do primary care in the rural setting," she says. "During orientation, the instructors talked about how rewarding it is to work in underserved communities. A female instructor said the women in one small town opted to see her instead of the male physician.

"I anticipate the work will be strenuous. The instructors really want us to work together and to build each other up," Shanks says of her fellow students. "They want us to start working as a team."

The program is designed with 12 months of classroom work followed by 15 months of clinical rotations. "This is a very condensed, fast-track program of 105 weeks," Clark says.

Classroom work will cover such subjects as gross anatomy, medical physiology, patient evaluation, medical microbiology, clinical medicine, preventive medicine and community health, pharmacology, medical neurosciences, clinical nutrition and clinical medicine. Clinical rotations will include general/family practice, internal medicine, obstetrics and gynecology, pediatrics, orthopedics, general surgery, emergency medicine, geriatrics, psychiatry and rural/correctional health care.

"Reading is a big part of this, but a certain amount of time will be spent in lecture," Clark says. The PA staff includes five full-time faculty members and two part-time physicians. The program also will utilize distance education in which lectures will be conducted via satellite from professors in Lubbock. Some of the distance education topics will include microbiology, pharmacology, anatomy and neurosciences.

Physicians designed the PA program after a medical model. "There are a lot of similarities with medical school," Clark says. After graduation and passing national and state exams, a physician assistant is a skilled health care professional who is clinically trained to work under the supervision of a physician. "We're trained to think like a physician and to use that mindset as we approach cases," he says.

Teamwork is the basis behind the Physician Assistant program, according to Clark, who came to Midland from the Rio Grande Valley where he worked as a professor and physician assistant at the University of Texas Medical Branch-Galveston based on the UT-Pan American campus.

Clark began his career in the healthcare profession during high school at Blountville, Tenn., where he worked as an orderly. He graduated from the Licensed Practical Nursing program at Bristol-Sullivan Technical School in Bristol., Tenn. After several years of military service, Clark did additional studies in cardiopulmonary technology before attending the Physician Assistant program at the University of Oklahoma. He worked two years in a San Antonio physician's family practice and then opted for a graduate residency for PAs in surgery at the Albert Einstein College of Medicine in New York City. For his final round of studies, Clark moved across the country to attend City University of Los Angeles, where he obtained a doctorate in life sciences.

Before coming to Midland, he not only taught part-time at the University of Texas-Galveston Medical Branch in Edinburg but also worked full-time in a physician's practice. "In my practice in the Valley, the patients looked at me no differently than the supervising physician. I always introduced myself as the physician assistant, even though they often called me 'doctor.' I did stress tests, vascular exams and minor surgical procedures in the office. I got a lot of the cardiac or vascular patients because that was my background."

The physician assistant can fill a role in a rural area without needing a physician onsite, he explains. "Rural health is where physician assistants have been shining stars. There are more than 450 rural health clinics in Texas, and three-fourths are staffed by PAs. In hospitals with 50 beds or less, it's likely you'll find a physician and PA team for outpatient and inpatient services. I emphasize dedication between the physician and physician assistant team. PAs are trained as dependent practitioners and not as independent physicians."

Clark says he hopes to develop the PA program into one in which students can earn a master's degree. "By the time they graduate now, they already will have more than 180 hours of college work and that's more than what they need for a master's degree."

The program is using existing classrooms on the Midland College campus. However, through a $1 million contribution from Dorothy and Todd Aaron of Midland and a $1 million grant from the Abell-Hanger Foundation and $3 million from Texas Tech University Health Sciences Center, construction will start by the end of the year on a new medical science building at Midland College. The Dorothy and Todd Aaron Medical Science Building will house the TTUHSC Physician Assistant Program and Midland College's health-related programs. The new building will include classrooms, a conference room, computer library, interactive conference room, medical library, exam and trauma rooms and a student lounge. "Students essentially will be living here," Clark says.

Word-of-mouth about the program is spreading rapidly among area doctors, Clark says, adding that he already has had inquiries from local physicians about the first class of PAs.

Clark has been working on the program since July 1998, and it recently received accreditation from the Commission on Accreditation of Allied Health Education Programs. Satterwhite points out that not only was it accredited, but also the inspector gave it three commendations. "The inspector said he generally doesn't give any commendations, but he gave us three," Satterwhite says. "We couldn't have asked for a better site visit."

Clark says he has set some lofty goals for this new Texas Tech initiative.

"I want to make this one of the best programs in the country."

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The Last Word: HEALTH CARE AND THE GRAYING OF SMALL TOWN TEXAS
By Glen Provost, J.D., M.P.H., Vice President for Health Policy and Planning TTUHSC>

It is no longer news that the elderly population is the fastest growing in the United States. Today, only 13 percent of U.S. residents are over the age of 65, yet they account for almost one-third of national health care costs. This trend will intensify over the next decade as 75 million baby boomers reach age 65.

An increasing need for geriatric health services will strain federal and state budgets as well as family finances, and the quality of life for aging citizens and their families could be profoundly affected. And if the elderly reside in rural Texas, they may find health care isn't close to their homes. According to the Texas Center for Rural Health Initiatives, almost 90 percent of Texas' rural counties are medically underserved. Fifty-six rural counties have no hospital.

Much of the public policy debate raging in Washington and in state capitals centers on the viability of Medicare and Medicaid programs and the effort to address the needs of the aging population. Unfortunately, precious little public policy discussion is focused on population-based prevention or non-financial barriers faced by the elderly in their efforts to access health services.

Yet, it is imperative that greater attention be given to improving the elderly's access to health care and to the expansion of prevention programs. This will not insulate against the coming explosion in health care needs of the elderly, but it may help to cushion the blow. Fortunately, there are steps that can be taken in fairly short order that are not resource intensive. For example, there is growing evidence of the importance of various types of exercise for the elderly, including anaerobic activities like weightlifting. Also, it is widely understood that diet and nutrition can benefit the elderly in forestalling many health woes.

There are many other population-based programs that are especially beneficial for the elderly. Yet, the amount of funding, both public and private, spent in these areas is small compared to health care expenditures. Not only does prevention receive few resources, it rarely has a seat at the table during the national policy debates on how to deal with elderly health concerns. That must change if we are to have any chance of adequately responding to this growing problem.

It is also important to recognize that, at least for the rural elderly, simply increasing financial resources will not resolve the problem of lack of access to health care. Elderly residents in rural communities with money to pay for physicians aren't helped very much if there is no doctor available. It is doubtful that even the most generous federal or state health care programs now being considered would pay for such things as lost family wages when a son or daughter must take off work to drive a sick family member to another city or county.

The rapid advances in telemedicine technology and the growth of so-called mid-level health practitioners are two subjects that should be carefully considered for their potential for improving access of the rural elderly to health care. Texas Tech University Health Sciences Center has used telemedicine extensively in the correctional health care setting and has shown it to be medically efficacious. Currently, telemedicine's cost effectiveness is being evaluated in both correctional and rural settings. Experience has shown that it is very difficult for remote, rural communities to recruit and retain physicians.

It may be that many of these communities will instead utilize nurse practitioners, physician assistants and pharmacists as front-line primary health care resources. When provided with consultative access to primary care and specialty care physicians through telemedicine, these health care professionals can be very effective in meeting many of the health care needs of the elderly and others living in rural areas.

It is obvious that the current health care system is not responding to the health care needs of rural residents, a fact that is particularly troublesome for elderly rural residents. It is essential that some "outside the box" thinking be applied to this subject. Not doing so will likely result in the current situation only getting worse.

(Reprinted by permission from the June 1999 issue of Health Law News.)

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