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FEATURE STORY 03/01/2009
Author: Aimee Bealer  
Providing Urologic Care to Veterans
A hobbyist skydiver with over 300 jumps under his belt, Army Veteran Daniel McPartlin, PA-C, took a leap from serving his country to serving patients as a PA. A specialist in urology at Hunter Holmes McGuire Richmond Veteran's Affairs Medical Center (McGuire VAMC), in Richmond Virginia, McPartlin says it was during his four-year stint as a combat medic in the 82nd Airborne that he became aware of the PA profession.

"I was first exposed to physician assistants as a young medic at Fort Bragg," he recalls. "Much of the primary care in the Army is delivered by PAs. I was very impressed by their level of knowledge, diversity and clinical skill set. I was drawn to the PA field because it would allow me the opportunity to gain a responsible position in medicine and build on my prior medical experience."

McGuire VAMC is a 427-bed facility offering primary, secondary and tertiary healthcare in medicine, surgery, neurology, rehabilitation medicine, intermediate care, acute and sustaining spinal cord injury, skilled nursing home care, and palliative care. As a urology PA at the largest medical center for veterans in the mid-Atlantic region, McPartlin finds many opportunities for professional growth and on-the-job education. "As a referral hub, the Department of Urology provides both routine and specialized urologic care to veteran patients in Virginia and several neighboring states," he explains. "We are extremely excited that our facility will soon be one of the first VA medical centers to offer robotic surgery for prostate cancer patients. As a teaching facility, the McGuire VAMC is affiliated with Virginia Commonwealth University and supports an eight resident urology training program. McGuire VAMC is one of the four lead clinical sites in the country that specializes in traumatic brain injury."

After completing four years of distinguished service in the Army, McPartlin came away with his paramedic certification and put it to use in a job with the Womack Army Medical Center in Fort Bragg, North Carolina for almost a year. He then took time to earn his Bachelor of Science degree at Excelsior College in Albany, New York and his Physician Assistant Certificate at the Albany-Hudson Valley Physical Assistant program.

Shortly before receiving his PA-C, McPartlin moved to Virginia to complete his last months of clinical training in a rural healthcare setting, expecting his stay to be temporary. But after graduation he opted to stay in Virginia and took a position in emergency medicine while looking for a more permanent opportunity.

"I always wanted to work at the VA and they had an opening in urology," remembers McPartlin. "I was lucky, I went into it and it fit my personality. When I was in school we used to rotate through areas to get the background to be a generalist. Urology was pretty interesting because of the breadth of diseases involved. Plus, there are quality of life issues that, if addressed, can help people feel much better."

McPartlin has been a practicing PA at McGuire VAMC for five years. A busy father of three little girls, he also works weekends as an Emergency Room PA at VCU Medical Center in Richmond. "Emergency medicine is like the Wild West; anything and everything comes your way. The training I got in the military got me in the mode to handle that. As a medic paratrooper, traumatic injuries were common in the drop zone. Most of our jumps were at night, so it was pretty interesting to provide medical care in that environment."

At McGuire VAMC, about 90% of the urology patients McPartlin sees are men. That number is shifting as more women are serving in the armed forces "I have inpatient, outpatient and procedural duties," he elaborates. "I work closely with attending urologists and resident physicians. I specialize in male general urology, oncology, and voiding and erectile dysfunction (ED). We treat many urologic malignancies including prostate, bladder and kidney cancer. I am privileged to assist my patients through all aspects of their treatment and recovery. The residents frequently rotate to different hospitals throughout their training so I am a familiar face to the patients and help provide continuity of care. I supervise a men's health clinic. Sexual health is an extremely important quality of life issue for men and their partners. We offer all the latest treatments for ED. I also enjoy performing procedures and have privileges to perform cystoscopy, urethral stent removal, transrectal ultrasound, prostate needle biopsy, surgical assisting, pre-operative history and physical examinations."

Along with two endocrinologists and a geriatrician, McPartlin recently launched a multidisciplinary men's health clinic within McGuire VAMC primarily for patients with ED and hypogonadism. "Most of the time people take care of their specialties on their own and refer patients to other specialists for other problems," he says, "but this time we have a team that is going to collaborate to develop the best outcome for the patient. Our goal is to offer the most dynamic and comprehensive services in the arena of men's health to our veteran patients."

McPartlin points out those health problems that lower male testosterone levels, such as ED and hypogonadism, are expected to continue to increase. He hopes that creating a clinic to address these issues will help patients avoid developing more serious health conditions. "Erectile dysfunction has important cardiovascular implications. ED is often a sign of underlying vascular disease and can be a harbinger of more serious things to come, such as a heart attack," stresses McPartlin.

In addition to seeing patients and working in the new clinic, McPartlin is involved in several research endeavors at McGuire VAMC. "I stay active in the department's diverse clinical research program. Right now, I'm a study coordinator for a urethral stricture study and a sub-investigator for an incontinence trial. I find that my job is constantly changing. I manage to do some writing, and I get involved in research because I'm always looking for something new."

McPartlin's role in the urethral stricture study involves investigating two different treatments that can help to alleviate narrowing of the urethra. "The point of the research is to find the best way to carry out care," he reports. "We randomize patients to one treatment or the other and chart their progress to see which treatment is superior."

In addition to the research he is currently involved with, McPartlin recently completed an investigational study on drugs that support bone health for patients who have prostate cancer. "I hope that my participation in these research endeavors may in some small way advance clinical urology and ultimately improve the lives of our patients," says McPartlin, adding that he often asks to be involved in research efforts in order to learn more about new treatments and drugs that might help patients.

McPartlin says he feels a kinship with the patients at McGuire VAMC because of their shared military background. "For me the VA is a very special place to work. I take care of people from all different backgrounds, but they all have something in common. When the Vets know I'm a Vet, it's like when you've gone to the same college; you instantly know something basic about each other because of the shared experience of military service."

"I think the hardest thing about my job is letting a patient know that they have cancer. It is sad to see people have poor outcomes from surgery or informing a patient that they have a condition that can't be cured," he laments. "I always want to try and help, so it is hard when there are some things we just can't fix." But McPartlin is excited that McGuire VAMC will soon be able to offer da Vinci robotic prostatectomy to patients with prostate cancer. "It is the biggest thing in prostate cancer treatment and we will be one of the few VA hospitals in the country to offer this technology to our veterans. Patients are asking for this treatment because there is no large incision and the recovery is quicker, and fewer days are spent in the hospital. We've gotten approval and will have the equipment soon," he reports, adding that McGuire VAMC has recently recruited a urologist trained to perform the procedure.

McPartlin foresees that he will continue to specialize in urology and is planning to pursue a master's degree in physician assistant studies. He imagines that more and more PAs will choose to specialize, much like their physician counterparts. He also believes that physicians will increasingly recognize the value of a PA's role in medicine. "It seems like doctors are coming to rely more on PAs because we can do 80% of what they can do, which frees them up to use their more specialized skills," he notes. "The PA profession is strong and our future is bright. In the last two decades, PAs have made major strides in broadening our scope of practice and levels of autonomy. As a profession we have matured and established ourselves as significant contributors to the healthcare system. However we must not allow our hard earned status to diminish through complacency. I believe that PAs should strongly support the profession at the local, state and national levels. These organizations promote pro-PA legislation and maintain a strong voice for our profession," asserts McPartlin, who is a member of both the Virginia Academy of Physician Assistants and the American Academy of Physician Assistants.

McPartlin advises future PAs to first become EMTs and gain basic exposure to medical care. "It's important to see if it's the thing you'll really be interested in," he explains. "The PA profession is a good way to get a responsible position in medicine. It is pretty portable from one specialty to another and offers a comfortable income with plenty of diversity. I would encourage any PA to look at a career with the VA. The VA offers stable and robust career choices with limitless opportunities for advancement.

"Coming to the VA hospital has been the best decision I ever made. I have the opportunity to practice medicine under some great physicians and serve those who served our great country. I have cared for men and women who served heroically in every major conflict since World War II up to the present wars in Iraq and Afghanistan. The price of freedom is clearly visible within the walls of a VA hospital. Emotionally, it is difficult to see wounded soldiers returning from Iraq and Afghanistan. But I'm inspired by the courage and determination of our soldiers as they confront their injuries and work towards recovery."

Daniel McPartlin, PA-C, received his Bachelor of Science from Excelsior College in Albany, New York. He earned his Physician Assistant Certificate from the Albany-Hudson Valley Community College Physician Assistant program in Albany, New York.

Aimee Bealer is a freelance writer from the Baltimore area. She is on the editorial staff of NEWS-Line for Physician Assistants.
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