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FEATURE STORY 04/01/2009
Author: Daniel Sean Kaye  
A Lifetime of Helping Keeps Him Going
In his 72 years, Edward Zwanziger has seen many things and has reached out to many people. From decades in the service of his country to his later years running disaster scenarios and helping patients of all ages return to health, he has seen the value of being a physician assistant. He is a lifelong healer whose work is not nearly finished. Edward W. Zwanziger, PA-C, works for Primary Care Associates, in Gun Barrel City, Texas.

Zwanziger was in the United States Air Force for 18 years before beginning a PA program. "I wanted to be a mechanic and was assigned as a medic," he recalls. "Initially I was receiving on-the-job training, then I attended formal medical technician (medic) training, including independent duty medic and other specialty type programs," he says.

Among the initial group of students selected to take part in the University of Nebraska Medical School's Allied Health Physician Assistant program in 1972, Zwanziger's early work was at Sheppard Airforce Base in Texas, followed by six-month clinical rotations at Westover AFB in Massachusetts, and six months at Carswell AFB in Texas.

"I was one of the original USAF military PAs," he says. "This was my training and became my career and profession. The PA profession was my military work from 1972 on [and] it was an honor to be one of the first PAs," he says. Still, he adds, there were growing pains in the field, such as gaining acceptance by other professionals and patients, and being initially overtrained in some areas and undertrained in others.

When he left the military in 1988, Zwanziger was happy he had done the PA training. "As a military medic, I could not apply my skills and training in the civilian environment when I retired. The PA program gave me the opportunity to advance my education and use my military experience as a strong foundation," he says.

When Zwanziger looks back on accepting the PA challenge, he realizes something he could not possibly have known all those years ago. "I was not aware of the significance this assignment was going to have on my life," he says. "I had no prior interest in medicine, but I have always been willing to assist others." And with no close family members or mentors in any part of the medical field, Zwanziger's medical foundation is wholly based on what he learned during his time with the military.

For 30 years, Zwanziger worked as a PA in many venues. He was a faculty member at Miami Dade Community College School of Nursing; a faculty member at the University of Texas, Austin, Department of Physical and Health Education and director of the EMS training program; a healthcare provider and clinic manager for a rural health clinic; and a family practice emergency medicine physician assistant, among other things.

About five years ago, Zwanziger, then 67, decided he wanted to slow down from the hectic and emotional pace of family and emergency medicine. Semi-retired, he joined Primary Care Associates, a small outpatient care facility in Texas. He works part time, mainly covering for staff when they need time off. "It keeps my skills current, and gives me a purpose," he says. "I knew the medical director and he was looking for some backup for vacations. My training was adequate for the job description."

The clinic offers family medicine, pediatrics, GYN, HTN, diabetes care, internal medicine, sports medicine (including sports physicals at schools), and house calls for home health and hospice patients in the practice. The mostly family medicine practice has a patient population that ranges from birth to the elderly. "The PAs (and other mid-level providers) that I associate with apply their skills to the health and welfare of the patients and their families. Those of us that have been around for a while do take advantage of opportunities to share the progress and achievement we have made," he says.

Zwanziger says his favorite responsibilities and duties include acute care and patient education. Acute care patients vary a great deal, he says, and include such healthcare concerns as upper respiratory infections, lacerations requiring suturing, foreign bodies in eyes or ears requiring removal, and fractured bones requiring casts or splinting. Patient education involves many subjects including diabetes, hypertension, immunizations and teen sex abstinence, he says.

While Zwanziger doesn't see his work as difficult, he admits that it does require dedication and compassion. He believes that the most important thing he does is to help provide access to care for the families he sees. "I accomplish house calls, assist with compliance issues, and construct structure to enhance daily tasks in the clinic (shelving, chart holders, equipment holders, etc.)," he says.

Feeling that his job never truly gets dull, Zwanziger says that some of the more interesting things he has had to do as a PA include: response to disasters, helping communities develop disaster plans; going to area schools to perform sport physicals; witnessing the pediatric patients grow and mature over the years; and giving parents recognition for providing their children direction, discipline and compassion.

One area Zwanziger is especially proud of is being a member of the Scott & White Speakers Bureau, in Temple, Texas, teaching about teen sex abstinence in their nationally recognized "Worth the Wait" program. He goes to area schools and churches to facilitate the abstinence talk and discussion.

In the area of disaster training, Zwanziger has been very active in providing such training for organizations and communities. He began doing disaster training in 1961, assisting people in their ability to respond to a variety of disaster situations. The trainings and exercises—for medical and non-medical personnel such as members of the military and civilians—included: mass casualty exercises, where he set up scenarios with multiple casualties to give the organizations the opportunity to evaluate their response capabilities; moulage training, where he taught people how to generate realistic wounds and injuries for training purposes; resource consulting, where he helped explain the importance of utilization of resources, especially in a disaster situation with limited supplies; and served as a rural health clinic consultant, developing policies and operational guidelines to meet federal criteria to qualify as a rural health clinic.

One thing Zwanziger learned through all this was that many communities have improved their efforts since 9/11 and the devastating natural disasters that have occurred ever since. "Prior to that, there was a significant amount of denial to that," he says.

He did learn some important things about disaster readiness. "Some communities have no backup for communication or for resupplying during a crisis," he says. "It is remarkable the impact any kind of training has on the actual response to a crisis, even when you think the training went poorly. I also let folks know there will some kind of training exercise (so they can start thinking about it before it occurs)," he says. "I like to do training, not testing. The testing will occur during the real thing."

Along these lines, recently Zwanziger returned from 10 days near the Texas Coast (Orange and Bridge City), responding to the needs of Hurricane Ike victims. He joined Active Community Team Service (ACTS), a faith-based organization, to provide acute care to patients and provide refill of maintenance medication.

In his field, Zwanziger believes the greatest challenge surrounds meeting the patients' needs in a timely manner and providing access to care. He says that the main stumbling blocks are being available for when the patient's condition needs you, and finding the appropriate resources for the patient. Many times resources are not available when the provider is, and vice versa, he says. There are also issues with insurance, lack of insurance, no gas money for travel to facilities, and no communication when phones are disconnected, says Zwanziger. Establishing a referral to a specialist can also be a challenge. "I don't like the fact that there are some folks that cannot maintain consistent care due to financial constraints." For those who are limited to care due to money issues, Zwanziger's facility keeps a list of resources and services available and they work to initiate the assistance.

These problems notwithstanding, Zwanziger truly likes having the opportunity to respond to his patients' needs. "My profession is rewarding. Patients are looking for help or relief from a medical problem. My skills enable me to respond to those needs," he says. Zwanziger only makes about two to three house calls a month, but it is a service he wants available for those in need, if required.

Another issue, says Zwanziger, is that it is important the public understands what a PA is and what he or she does. "I am an extension of the physician, not a replacement," he says, adding that as a PA, he provides referrals to specialists or to the medical facilities that can help the patient. "It is unfortunate that some physicians still feel we are competing with them. As a PA, I must be affiliated with a physician. I make a concerted effort to work with physicians and do not and will not compete with them. The physicians that feel disharmony are generally those that have not had the opportunity to work with PAs and are not familiar with the philosophy," he says.

Part of his job that goes a long way to helping to better educate people regarding PAs is when Zwanziger shares aspects of his knowledge with colleagues and co-workers. This includes updates learned from the one or two conferences he attends each year to keep up his continuing medical education requirements, new techniques he has learned and changing medication modalities.

Zwanziger has watched his field change a great deal since those early days, nearly 35 years ago. "There have been major advances in the PA profession and recognition from the patient community. It has been a progressive time. We have been able to demonstrate to the public that we are qualified professionals and do provide quality healthcare," he says. "Legislation has enabled the PA to be a significant part of the healthcare profession."

On this point, Zwanziger feels that today's PAs might not realize how much better life is for a PA in 2009. "I have the good fortune to relate to the younger PAs just how good they have it now. We have come a long way, baby. The younger ones do not have the growing pains we had. The profession is recognized, we have gained the trust of the patients and patients depend on us," he says.

Is being a PA enough for some people? Zwanziger says that PAs should "remember we are not physicians; we are physician assistants, and if that is not fulfilling enough, [you] should go to medical school. Some PAs are very smart and gain great knowledge and skills. However they may be limited due to being a PA and may have a tendency to be offended," he says.

Zwanziger says that being a physician assistant is not a job, but a profession. "It requires dedication and compassion. If the youngster wants to be a PA because it is a good way to earn a living, then seek another career," he says. "PAs add access to healthcare, provide a team approach to the care of the patients," says Zwanziger. "The physician/physician assistant concept is a dynamic combination and a significant part of improving the quality and access to care for our communities."

Edward W. Zwanziger, PA-C, RN (inactive), has his associate's degree in nursing from Miami Dade Community College and his bachelor's degree in Allied Health (physician assistant) from the University of Nebraska Medical School.

Daniel Sean Kaye is a writer from the Philadelphia area. He is on the editorial staff of NEWS-Line for Physican Assistants.
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