Recruiting advanced providers is extremely competitive. There are typically more open positions at most organizations than qualified candidates. In addition, as a group, physician assistants, nurse practitioners, and other advanced providers change jobs more frequently than physicians. So, creating a great work environment for these professionals should be a high priority for any organization seeking to improve advanced provider retention.
Perspectives recently spoke with two CEP America physician assistants (PAs), Jed Grant, PA-C, and Matt Keane, PA-C. As PAs with the Army National Guard, they share insights into why military veteran advanced providers can be a great addition to a civilian healthcare team.
Perspectives: What is practicing in the military like?
In the military, the PA is generally the first stop for healthcare for the men and women in a battalion. The PA travels everywhere with the battalion and is responsible for between 300 to 800 people. Part of the PA's role is to train medics, who have a very broad scope of practice compared to the civilian world. The PA is responsible for deciding the scope of the medic’s role to some extent and for training them to perform delegated tasks.
In the military, there is a strong focus on working autonomously, because there isn’t a doctor just across the room to consult. If you want the patient to see a physician, it might involve putting the patient in an ambulance or helicopter, so it’s a much different utilization of resources.
Practicing in the National Guard can really vary, depending on the kind of unit you’re assigned to. I’m with an infantry unit, where I’m responsible for about 25 paramedics or army medics. We handle a variety of things when it comes to soldier care, including taking care of illnesses and injuries. We also do a lot around primary care and preventive healthcare. In my unit, we’re kind of like the emergency medical system, getting the soldiers off the front line, making sure they’re OK, and then moving them backward or to a higher level of care.
We work a lot more independently than PAs normally work on the civilian side, because we generally don’t have direct access to a doctor if there is an issue. We have a set of protocols and privileges that we follow, and our supplies and location often limit how we practice. So there's a lot of problem solving involved.
Perspectives: How does the military prepare PAs for a career in civilian service?
The basic physician assistant training is the same in the military and civilian world. The accreditation and curriculum are the same, but military PAs often receive a lot more advanced training after graduation, such as a flight medicine and trauma courses. The Army also has a postgraduate fellowship in emergency medicine. Most military PAs leave the service very well trained. Military PAs and NPs are also comfortable working with electronic health records and have some understanding of coding and billing issues, so they’re usually prepared for civilian work settings from that standpoint as well.
When looking to hire a veteran or someone who is leaving active duty after a number of years as an advanced provider, it’s important to know that you’re hiring an experienced employee. PAs leaving active service with the Army typically have four to six years of experience. You’re also hiring someone who is used to structure and who is very self-motivated and self-disciplined.
Perspectives: What should potential employers know about military advanced providers?
As the first level of healthcare for people in the field, military PAs are used to problem-solving and working in stressful, fast-paced environments. In the ED, our job is to admit or send home, and veterans are used to thinking in those same terms. For example, they have to decide to evacuate the patient or return him or her to duty.
There’s a perception out there that people who have been to war and seen combat are somehow damaged, but that’s not necessarily true. It does leave an impression, but it doesn’t mean veterans can’t function well in a civilian hospital setting and get along with everyone.
An employer should always hire the best and most qualified candidate. That being said, I think it’s important to give some extra weight and merit to a veteran with respect to the soft skills we look for in employees, such as communication, punctuality, and professionalism. Veterans have a lot of these characteristics and they come with a lot of intangibles and experience that a new graduate may not have.
Perspectives: What are some suggestions for setting veteran advanced providers up for success?
It’s important to be aware that veteran advanced providers are used to seeing a fairly narrow patient population, typically between 18 to 45 years old and generally healthy. Musculoskeletal injuries and trauma are the things PAs in the military most commonly treat. There may be a bit of a learning curve as they adjust to seeing a broader range of patients, from neonates through seniors with a variety of health concerns.
On the other hand, I know a lot of people who moonlighted in civilian EDs throughout their military career, so they wouldn’t have a problem transitioning immediately.
In the military, there’s much more focus on figuring things out yourself and functioning autonomously. It’s important to help veterans understand that the level of oversight and collaboration in the civilian world is a little greater than in the military and to make sure veterans are comfortable talking about cases or situations they're unsure about. You want to make it comfortable for them to utilize the easy access to physician colleagues that may not have been as available to them when they were in the military.
As Jed mentioned, someone transitioning from a military to civilian setting may be used to working independently with a lot less staff and other resources. So, coming to the civilian world and having to understand the roles and responsibilities of different team members could be a challenge. I think explaining the roles of medical assistants, registered nurses, licensed vocational nurses, and other colleagues during an orientation period would be beneficial.
Also, a lot of military veterans, especially those just coming from active duty, want to stay connected to the military, either as a Reservist or in the National Guard. Offering incentives like paid military leave can help make the transition to civilian life easier and allow veterans to maintain that military connection if they choose.