At age 21, Frank Boyd was hospitalized with a pulmonary embolism, an event that was to change the direction of his life. For the two months of his hospitalization in 2001, he watched and listened as the nurses cared for him. “I started asking them questions,” he says. “After that, I knew where my career was. It was in nursing.”
Given that Frank was employed in the constructions trades, the transition to a health profession was unexpected. “If you knew me before all of this you would never have predicted I’d go into medicine, or to be a nurse in particular. I was not that person.”
But it was his firsthand experience of being a patient in the hospital that gave him empathy for others going through the medical care system. For nine years, Frank Boyd worked as a nurse in the Intensive Care Unit in the University of Kansas Medical Center.
“Patients are obviously scared,” he says. “They’re in the ICU, so they’re close to death. In some sense, I know what that’s like. I know the fear of their family members, that they’re as scared if not more so than the patient. The patient is sick and might not really understand what’s going on. The entire time their loved ones are lying there in bed, you’re explaining things to the family members. There’s a good chance of them dying, or not coming back the way they were.”
That was serious business, life or death.
Right now, Frank is in his second year at MEDEX Northwest—the clinical year—studying to become a physician assistant. We caught up with him during a one-month surgical rotation at Group Health Central Hospital under preceptor Neil Weigand, PA-C, himself a graduate of MEDEX Seattle Class 39 in 2007.
Frank, so accustomed to the adrenalin of urgent care, is adjusting to patients who come in for routine exams and procedures. “A sick kid, I don’t know much about,” he says. “Are they really sick, or is this just a cold? Whereas you can be an older adult that is bleeding out or really septic, and I know exactly what to do. It’s an odd situation. I’m less familiar with the less acute patients.”
But Frank is in learning mode, and he’s a quick study. At Group Health, Neil Weigand along with other PAs and physicians have assumed a role in his education. “They’re really great about helping me out, teaching me new things, grabbing me when there’s something interesting going on. They’re giving me a good, well-rounded experience of in-patient stays with surgical patients.”
As an ICU nurse, the in-patient and patient management aspects were completely routine to Frank, but the surgical portion is something entirely new. “I’d never been in the OR for more than an hour or two when I had to manage something about a patient as an ICU nurse,” he says. At Group Health, he’s worked as a surgical first assist, executing lots of surgical closures.
We wonder how his skills with closure stitches have come along.
“Okay,” he says. “The speed is not there yet, but they look nice.”
Frank views his years in nursing as something that informs his current direction. “I enjoyed my experience as an ICU nurse,” he says. “I wouldn’t go back and become a PA at 21 years old. I sat with patients at their bedside, something most PAs don’t experience, or even nurses outside of the ICU. I watched people go through these things and come out the other end, surviving and thriving.”
Now, with his sites set on the PA profession, Frank sees a different emphasis.
“I’m looking to prevent people from being in the hospital in the first place,” he says. “I don’t want to see these patients in the ICU anymore when we could prevent this.”
Frank is outspoken about what he sees as a healthcare system that is not geared towards prevention. “My frustration with our current system is that it’s built to fix broken people. We can prevent the brokenness in a lot of cases—not all, but most cases.”
What Frank is talking about is the fact that medical insurance does not allow providers to bill for patient education. This leaves huge holes in patient care. A provider can bill an open-heart surgery at thousands of dollars, but they must apply a dramatically lower billing code for an outpatient appointment to educate patients.
“It takes more than 15 minutes to educate a patient,” Frank says. He saw this every day in the ICU. “People were told, ‘Well, you’re diabetic,’ but not given instructions on what to do with nutrition, with their meds, nothing. We are not listening to our patients like we should in the first place. It’s important that we’re able to see where they’re at and then help as they need to be helped. We just give them orders and hope it works out, and when it doesn’t, we’re surprised. Well, we shouldn’t be. We’ve failed them.”
Drawing upon his own experiences as a patient, Frank sees an advocacy role in his new career.
“As a PA I hope to be empathetic as a way to get into patients’ lives before they land in the ICU,” he says. “In the ICU I’m kind of powerless, except to try and do what’s best for them in the moment. But it’s too late in most cases.”
As a physician assistant Frank hopes to intervene with patients prior to their first admission. At the very least he’d like to see medicine take a more active role in educating patients about making better choices as a way to prevent them from cycling in and out of hospitals. That said, he doesn’t believe scaring patients has any effect. “Instead, I like to emphasize the importance of what they can do for their own health, and get family members involved as well. That would save a lot of money, a lot of time, a lot of pain for them, and a lot of frustration for us as medical professionals.”
Frank continues. “Either way you look at it—whether you’re conservative, democrat—it doesn’t really matter. The issue is that preventative care is dramatically cheaper. And it prevents people from having to go through heartache. The lifestyle improvements these people can have is dramatic. I don’t see why there would ever be an argument with this. One of the obstacles I see is our insurance billing system.”
Preventive care doesn’t get headlines. “Most other countries have figured this out, but it isn’t sexy.” “Primary care is looked down upon, which I don’t understand. They have to be good at a little bit of everything. They have a broader knowledge than I would ever have as an ICU nurse. Primary care isn’t seen as exciting, it’s not billable; you can’t make money. I can make 75 bucks for a patient visit, or I can be in ICU and make $250 for a visit for the same 30 minutes.”
Frank doesn’t question medical students who graduate and plan to go into medical specialties. “They leave $300,000 in debt, and are offered $150,000 a year when they come out in their mid 30s. I don’t blame them for going that route.”
Of course there are PAs who move into specialty medicine as well. “Even those of us planning on specializing still feel that family medicine holds an important role in our system that cannot be forgotten. In the back of our minds we’re thinking about nutrition, exercise, all of those preventive measures—really basic and cheap solutions—that can make huge lifestyle transitions for patients rather than another pill.”
“But if our system is built where I can bill for the pill, but I can’t bill for the education, that’s wrong. It doesn’t make sense.”
Frank believes that healthcare must improve its effectiveness with education and listening to patients. From there, systems can be built that are most effective at addressing patient needs. As things are today, neither patients nor medical providers are well served.
“We’re burning out our providers,” says Frank. “We’re working harder, longer hours and getting worse outcomes. Even if we are making more money, in the end, for the majority of us, it’s still burning us out. I couldn’t see those poor outcomes over and over again when there’s a system out there that can be fixed.”
Franks sees the possibility of real change coming about through professional and political alliances.
“Physician assistants don’t have much clout because there just aren’t that many of us compared to nurse practitioners and medical boards. We’re smaller by a wide margin. But I think PAs can partner with groups like the American Medical Association, the Washington State Medical Association and the nursing board here in Washington. We’re all aiming for the same things: improved healthcare and lifestyles for healthcare providers that the current system is not allowing.”
Frank believes the current healthcare system can be changed through combined lobbying efforts to allow for billing of patient education. “Instead of being told we’re doing a poor job, we could be effective at what we started this job to do. We could function at the top of our license.”
Frank Boyd listens to the patient's heartsounds.
It’s clear that Frank Boyd isn’t shy about speaking his mind. We wonder how he developed such candor.
“It might be a little bit of a Mid-Western thing”, he replies. “I’m from Kansas, and we’re pretty straightforward. We don’t hide much. We’re nice, but if there’s something wrong, we’re going to address it, and sometimes we may irritate people by doing that. I worked with four nurses from Kansas at my last job. And we were known as ‘The Feisty Kansans’. If we saw something wrong with patient care, with staffing or something, and we would fix it. We wouldn’t just complain about it. This wasn’t to hurt people’s feelings. It was because there was a problem that needed to be solved, and we had the power to do it.”
Group Health Central under Neil Weigand is Frank’s third clinical rotation and fulfills his surgical requirement. Next he will be at Bellevue Group Health in Urgent Care, an area more familiar to Frank after his nine years as an ICU nurse. His clinical year concludes with a 4-month family medicine preceptorship in Port Townsend, WA that starts in April of 2017. Graduation follows at the end of August.
We ask Frank where he sees himself after leaving MEDEX Northwest.
“I’m trying to allow these rotations to kind of shape where I’m supposed to belong in medicine,” he says. “I’ve had a past in ICU, and I see those skills that I’ve utilized in this rotation even now. I don’t want to throw away those experiences and that knowledge that I have for in-patient medicine.”
“What I hope to gain as a PA is the medical knowledge and the credibility to be able to work in people’s lives outside of a hospital, to be in primary care. Even to become a hospitalist if I choose, or perform surgery for minor procedures—anything I can do to help prevent these huge catastrophic events.”