Megan Giddens has always been interested in medicine. But she didn’t know she wanted to be a physician assistant – also known as a physician associate (PA) – until she was a freshman in college. There, she said, she found a role that combined her passions.
“I can still practice medicine,” said Giddens, now a second-year PA student at OU Health Sciences. “The PA role is very interesting because you really can work in a lot of places and just increase access to health care, and that was something that was really important to me.”
The role’s flexibility uniquely positions PAs to expand medical care, which Giddens said is necessary in rural communities. None of Oklahoma’s rural counties have enough primary and mental health care providers, leaving a limited workforce to wear multiple hats to meet needs.
“The more we can do, especially in a primary care setting, to not send people out to other providers when we can do it all in one place – I think that is a huge advantage, especially in those rural communities,” Giddens said.
A new OU Health Sciences initiative fueled by a federal grant aims to do just that by sending PA students on three-month rotations in rural primary care clinics that integrate mental health services.
Ideally, that integration means if someone’s mental health comes up in a primary care visit, a patient can receive support from their provider or another person on site.
The program began last October through a five-year grant of $2 million from the Department of Health and Human Services’ Health Resources and Services Administration. It combines OU Health Sciences PA students’ primary care and mental health rotations.
So far, it’s attracted three Oklahoma health systems to host students — Okeene Municipal Hospital and Medical Clinic, the Iowa Tribe Perkins Family Clinic and the Health and Wellness Center, which has a network of locations across eastern and southeastern Oklahoma.
Mary Gowin, a co-leader of the grant, said resources were built in for development, meaning they can help future partners who need support to host students.
“Going from a traditional four-week or eight-week rotation to hosting a student for three months is a bit of a shift in terms of [rotation sites’] time and energy and their commitment,” Gowin said. “And they were just so gracious and said, ‘Yes, we'll do it, whatever it takes.’”
Gowin said stipends help cover students’ housing, mileage and meals. Eventually, the goal is for all OU's future PAs to participate.
The university hopes the temporary rural placements could turn permanent post-graduation. Students like Giddens and Laureli Simpson said that could be a possibility.
Both recently completed rotations through the grant, with Simpson working at the Health and Wellness Center and Giddens with Okeene Municipal Hospital. Giddens’ primary supervisor was family physician Dr. Cayci Brickman.
“I do mental health needs on almost every single patient that comes in my door. … It's just connected to every other part of their body, every other medical issue and challenge they face,” Brickman said. “If you're not controlling the mood, the sleep, anxiety, you're really going to have difficulty regulating hypertension, diabetes, all of their chronic issues as well, because it's so integrated.”
Brickman said Giddens learned everything from how to help people manage their diabetes and ADHD to coping with anxiety and depression. Giddens also spent time in group and individual counseling sessions through the hospital’s Senior Life Solutions, which is an intensive outpatient therapy program that serves seniors struggling with depression and anxiety.
Brickman said she enjoyed it. And so did her community.
“Three months has allowed the student to follow some patients and see patients multiple times,” Brickman said. “Actually I'll have patients come back in, ‘Oh, you know, where's Megan?'”
Simpson said she came out of her rotation feeling more equipped to become a knowledgeable and empathetic provider. She recalled one experience with a patient who was worried about getting diabetes because she couldn’t afford the medication she needed.
“You can't just say, ‘OK, here's [the] first line to treat,’” Simpson said. “You have to think about ‘Can their insurance afford it? Do they even have insurance? Can they get to where they need to pick up their medication? Can they even do the things and eat the right foods, or are they on food stamps and they can't afford the right foods?’”
“Things like that, that you don't think about in the classroom, I think these rural rotations really exposed us to that,” she added.
A good relationship with a provider can save lives. Jinni Reames, the program director of Senior Life Solutions, said she had a patient who wasn’t receptive to care at first, but after three months in her program, he admitted a call from her saved his life.
But, it can be difficult to find people who are willing to go rural. Reames said it took her a long time to find a therapist who specialized in geriatrics. Through rotations like OU’s, she said students can learn what it’s like to know and serve their neighbors.
“I really hope that by doing this, that we're going to encourage more to come to the rural communities and to seek more behavioral health areas, because that is just such a small area that we really need to grow,” Reames said.
Gowin said OU’s PA program is very focused on primary care, but there’s been a desire from faculty to increase mental health coursework and experience for students. Bruna Varalli-Claypool, a co-leader of the grant and PA program faculty member, said in conjunction with the new rotations, faculty are enhancing the PA curriculum with education on medication for opioid use disorders.
Providers from the Health and Wellness Center also trained students on mental health first aid.
Enhancing education in mental health to improve access to care is also an area that Oklahoma Senate Democratic Leader Julia Kirt is pursuing this session. Through Senate Bill 670, professionals like PAs would be required to receive one hour of continuing education in integrated behavioral health care and provide a mental health screening to patients before or during a primary care visit.
“We've done a lot in this state to try to attract doctors to rural Oklahoma and try to attract other health providers to rural Oklahoma and help them stay there,” Kirt said. “And so this, to me, is just an additional way to give them more training, more knowledge and really build out our whole network.”
Okeene Municipal Hospital CEO Clark Houser said he’s thankful his facility had the right “ingredients” to become a host for OU’s new rotation. He hopes the program continues to expand.
“If we're able to figure it out now, show value and then actually provide some of that reporting back to the providers of the grant money and the program, I think we're going to have a really good program,” Houser said. “We’re going to be full circle. They're gonna get the feedback they need. We're going to have more sites. We're going to have more students. … You're going to have more people that are living in communities like this that are providing that type of specialty care.”
“So, I think it's just the tip of the iceberg. But I think it's definitely a glide path after this.”
For Giddens, three months spent in Okeene was "eye-opening."
“I think getting to integrate both those components was really special, and it made me really kind of look at how I would like to practice in the future,” Giddens said.
Following this rotation, she said she feels more confident in her ability to serve in a rural area. She wants to return to northeast Oklahoma, where she grew up, and care for patients there.
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