Q&A with Heather Tonga, Family Practice PA-C, MS, Physician Assistant for the Homer Medical Clinic in Homer, Alaska
Heather Tonga, PA-C, MS, received her bachelor’s degree from Duke University in North Carolina. She received her master’s degree online from the California College for Health Sciences in 2001. Tonga is currently a PA-C for Homer Medical Clinic, a family practice in Homer, Alaska.
Q: What motivated you to become a physician assistant?
A: I was living in a small town in Alaska, working as a Community Health Aide (CHA). CHAs work for Native Health Service in very small towns and remote villages, providing primary healthcare when there are no other providers, except some visiting public health nurses, occasional visiting physicians, PAs or NPs. After meeting John Winkelman, a PA in Healy, Alaska, I was very impressed with his skills and knowledge, and that’s when I realized that I wanted to get more training and attend PA school.
Q: What kind of facility is Homer Medical Clinic?
A: Homer Medical Clinic is a private family practice clinic with four physicians, one part time FNP and three CNMs. We do the majority of OB care in our town. Otherwise, the clinic offers a broad range of primary care services and the physicians share call and ER coverage at the hospital. Our town has about 10,000 people.
Q: Typically, what are your day-to-day responsibilities??
A: I usually have most of my schedule full ahead of time, often with various types of physicals and follow-ups. The rest of my schedule is filled the same day, usually with urgent care. I do some chronic care management, but much less than I did in previous jobs, as the physicians tend to be the primary care providers for chronic disease management at this clinic.
I work with patients who suffer from respiratory infections as well as other infections. I also perform well exams for all ages as well as school, travel and work physicals. In addition, I also diagnose orthopedic injuries, rashes, UTIs, depression, anxiety, and hypertension as well as perform skin lesion removals and suturing.
Q: What is it like working in a small town like Homer, Alaska? What’s different about HMC?
A: In a small town, you know a lot of your co-workers and patients outside of work in different settings, including neighbors, parents of kids’ friends, and relatives of friends. Homer is a different sort of small town than the one I worked in in Washington because there are a lot of tourists and people that move in and out, although there are a number of long-term families as well. People move here to retire because of the arts community. Many people make their livings here commercial fishing or running tourist businesses in the summer, and are then unemployed or traveling in the winter.
My clinic takes care of a very wide range of patients. We do 90% of the OB care in town, and also the well baby care afterwards, so there are many young mothers and babies. We also have the largest Medicare and elderly population of patients and have contracts for a number of work-related exams, pre-employment physicals, Coast Guard, etc. The clinic is also unique in that many of the people who work there have been there a long time and a number of them are related to each other. Two physicians are husband and wife, one physician is married to a CNM, and the other physician is married to the ARNP. Many members of the staff are involved in some sports together outside of work, including softball, hockey, and running. It’s quite an athletic group.
Q: What are the greatest challenges you face?
A: We just lost our local psychiatrist, and so for most patients, we, as family practice providers have to manage their psychiatric medications. I have become much more skilled in this area, but I would like to have more back-up from specialists in other areas as well.
However, my biggest challenge is taking care of patients who have no health insurance or a high deductible. We have a large seasonal work force, and many patients who have no insurance do not have enough money to pay for medications, further evaluations that are recommended, or treatment.
Alaska has little options for privately purchased health insurance. I am constantly trying to figure out the most cost-effective way to manage patients and sometimes try to convince patients that it is essential that they get some type of further evaluation or treatment for their well being or survival.
Q: What do you like most about being a PA?
A: I like working with a great group of medical providers. We have similar work styles and I respect their care of patients. They are willing and good at advising me when I ask questions. The workplace is friendly and supportive of its staff, family, and patients, but also professional in its facility and systems.
This is the first job I’ve had that I got paid for the amount of work I do, rather than just getting a salary, and that is a good motivation for me to work harder and not mind longer work hours when it’s needed.
Q: Do you feel that the role of PAs has changed over recent years? If so, how?
A: I have been working in rural areas since 1989. I’d say that since I graduated, most patients know what a PA is and that wasn’t true 20 years ago. I think PAs have taken on more jobs that are more “independent,” like working in remote site practices, emergency rooms, or being the first on-call in a practice.
I like the respect that we have as a profession, and I am glad that state laws make it quite easy to practice to the full extent of our abilities. I do not agree with some of the independence that happens in workplaces though. I think employers in remote sites save money by hiring PAs and NPs, but don’t plan for the supervision and collaboration that should be happening for us to work our best.
I was in a remote site for 10 years in Washington, and the only reason I kept doing it was because I had excellent supervising physicians to consult with. I don’t think that’s happening as well as it should in a number of situations, and I think it’s very important for PAs to continue to be licensed under a physician with concrete plans for collaboration, including consultation and referrals.
Q: What do you feel is of the greatest concern to PAs today?
A: I think we should be concerned about the increasing cost of healthcare in our country, the lack of access to care for many patients, and the lower health measures compared to other developed nations. I think we need a large revision in how healthcare is offered, with a focus on preventive and primary healthcare, reimbursement related to quality of care and not quantity of care, reimbursement that is not so exorbitant for procedures, ER visits, and specialty care.
I think people need to learn about dying and end-of-life care instead of spending hundreds of thousands of dollars on care that doesn’t really make any difference in survival. I think everyone in our country should have access to basic healthcare services.
Q: If you could sum up your position in one word, what would it be and why?
A: Networking. Because I work with lots of different people, communicate with others, and try to get everyone working together to better the health of individuals and my community.
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