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Q&A with Glen E. Combs, MA, PA-C, Physician Assistant at Piedmont Psychiatric Associates in North Carolina | NEWS-Line for Physician Assistants

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FEATURE STORY 04/01/2012
Author: Staff  
Q&A with Glen E. Combs, MA, PA-C, Physician Assistant at Piedmont Psychiatric Associates in North Carolina
Glen Combs is a PA in psychiatry at PPA and lives in Winston-Salem, North Carolina. He graduated from the PA program at Alderson-Broaddus College and received his graduate degree from Michigan State University. Glen has been involved in the PA profession for nearly 35 years, and has had a very colorful and eventful career. He has chaired two university departments of PA studies, been elected president of the AAPA on two separate occasions, and has practiced in OB/GYN, emergency medicine, family medicine and psychiatry. Glen has also championed the advancement of the PA profession and has had the opportunity to be this nation's chief PA spokesman interacting with the AMA, American Academy of Family Physicians, National Commission on Certification of Physician Assistants, Inc. and the United States Congress on PA matters. He is the father of two adult children, and keeps busy clinically and by writing about the profession. Glen's first love is his wife Michelle, who is a practicing PA in hematology and oncology.

Q: What motivated you to become a PA?

A: My motivation to become a PA came from my family of healthcare providers. I was on track for a PhD in clinical psychology in 1968. This was a time of great turmoil, which surrounded thousands of young men for and against the Vietnam conflict. My friends were being drafted left and right. I knew I wanted to remain in the medical field so I completed a diploma program in nursing to finance my doctorial work in psychology. I was 17 years of age when I was told to report for my draft-mandated induction physical in Los Angeles—a boyhood memory I wish I could forget—given a draft card and assigned lottery number 89. I thought I was going to Vietnam without a doubt.

At about this same time my aunt, who was an RN supervisor at an El Paso hospital, sent me the famous Look magazine article on the Duke University Physician Associate Program. This was the best thing that had ever happened to me in my young years toward career development. I received an invitation for the Duke PA program and that got the ball rolling. I eventually received an invitation to join the class of 1973 at Alderson-Broaddus (A-B) College's Physician's Assistant Program, and the rest is history.

Q: Did you ever think about going to medical school?

A: Of course I did. I think every one of us in the PA program thought about going to medical school, and four of my classmates did. For me, going to PA school was more intriguing because it was a brand new occupation that literally no one understood or really cared about. We were the "disciples" of very courageous physicians (Stead, Myers, Silver and others) who were ridiculed for promoting a new group of practitioners who did not have a medical degree. We represented the fringe; the young whippersnappers who were full of ambition and optimism that could succeed in putting the PA profession on the map. Medical school was a little too tame for us. PA school—that sounded interesting.

Q: Did you have a mentor in PA school?

A: Dr. Hu C. Myers, who had established the first baccalaureate degree program for physician assistants at A-B, was my mentor. He was a genteel, Southern man who was very dedicated to training PAs.

Q: Can you describe your PA career path?

A: I graduated from A-B in 1973 and began my PA career in surgery. As one of the top students, I was chosen to be a PA surgical resident at Myers Clinic/Broaddus Hospital in Philippi, West Virginia. We were overseen by attending physicians and essentially trained as surgical residents. With wide-eyed amazement, I participated in amputations and skin graphs, and was involved in a number of surgical procedures.

I held that internship for 16 months, got married and then headed to the San Francisco area to work in internal medicine. In 1975, I went to Michigan State University on a paid fellowship through OMERAD, the Office of Medical Education Research and Development, and graduated with a degree in higher education administration with an emphasis on medical education. Soon after, I accepted a faculty position within the University of Kentucky, where I taught and also practiced in the ER department.

I was a tenured associate professor, but I'm someone who needs challenges—if there are no challenges, I'm not happy. So after working and developing friendships with some of the faculty, I was heavily recruited by Bowman Gray (now known as Wake Forest School of Medicine) in Winston-Salem, North Carolina. From 1989 to 2004, I worked for the college as the PA program director. I earned accreditation status for the program, increased its profile, acquired $3.5 million in grant money, and oversaw the change from a certificate to a master's degree program. I taught courses of my choice, handled teaching and administration duties, and had patient responsibilities two-and-a-half days a week in the OB/GYN department.

After nearly 15 years, I felt I had stayed too long in medical education. I made the big stretch to family medicine/primary care where I learned the latest in diagnostic procedures and saw patients of all ages. After that, I left and went to OB/GYN.

Q: How did you make the jump to psychiatry?

A: I would say approximately 30% of OB/GYN patients I treated had psychological issues—depression linked to domestic abuse, personality disorder, etc. I recognized those patients who could benefit from psychotropic medications; however, I was often limited to 10- to 12-minute sessions, which is not enough time to undergo psychological underpinnings.

I became good friends with a clinician at Piedmont Psychiatric Associates. When a position became available, I went for the job. This is exactly where I like to be, and I see myself finishing my clinical career in psychiatry.

Q: Typically, what are your day-to-day responsibilities as a PA in psychiatry at Piedmont Psychiatric Associates?

A: I complete an initial evaluation, make a diagnosis and develop a care plan.

Q: What type of patients/diagnoses do you encounter most frequently in psychiatry?

A: We treat patients 18 years and older. The diagnoses I encounter are what I call the bread and butter of psychiatry: depression and anxiety, followed by personality disorders (borderline and schizophrenia), grief management and delusions.

I probably refer a patient to hospitalization every two to four weeks. Addiction is rampant in society, and there are those drug-seeking patients who are referred to an outpatient site. In the last two-and-a-half years only two violent incidents have occurred within the office.

I've learned that "normal" is a setting on a washer or dryer—it's a hard word to define when used with people.

Q: Do you have a memorable moment with a patient?

A: In the last couple of weeks I had a patient come in with slurred speech, high anxiety and a headache. I referred her, and three days later she underwent an operation on a brain tumor. Primary care has been a perfect background to have when treating both a medical and psychiatric problem. I'm not sure I would have been as drawn into her symptoms without it.

Q: What do you feel are the biggest challenges to PAs today?

1. Our identity;

2. Widening our scope of practice;

3. Being properly reimbursed for our services.

Unfortunately this all ties to our "assistant" title, which misrepresents what we do. At my age and with my experience I've gained the respect of my patients and physicians, but there are many antiquated rules and regulations that govern what we do. For example, PAs have been around for 45 years, yet are tethered to physicians from a legal standpoint.

Q: Do you think the PA name change to physician associate will happen?

A: Yes, 100%. It has to be done if we are going to be taken seriously on a state and federal level. PAs do more than look at patient histories, conduct physicals and prescribe medications. We need the PA definition refined and modernized. It's taking pride in what we do, and also ethically wrong to portray a role that's misguided and confusing to patients. Physician associate is not perfect, but it helps clarifies who we are.

Q: How has your PA career allowed you to grow personally and professionally?

A: I love that I have championed the cause of the profession for 35 years, and I enjoy stamping out the misconceptions. I appreciate how multi-faceted the PA profession is (I have four different specialties), and I like that I get to meet influential people and have developed many friendships. I've had the opportunity to interact with people who need my services and never anticipated so much gratification in curing illness, comforting people and having a positive impact on someone's life.

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