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WAPA Pulse | 09/18/2019                                                                                                View this email in your browser
The Great Midwestern Medical Conference is right around the corner. If you wait, you'll miss out on early-bird pricing (ends September 15) and hotel group rates (ends September 30).

Clinical Pearls: New grants shine light on teen depression and suicide
According to the Dept of Health and Human Services, the average percentage of Wisconsin high school students with at least one major depressive episode in the last 12 months was 14 percent, slightly above the 2017 national average. Unfortunately, the suicide rate for youth in Wisconsin has been growing since 2007 and the state rate for youth dying by suicide is greater than the national rate according to a report from the WI Office of Children's Mental Health. Risk factors for suicide include mental illness, bullying, drug and alcohol use and sexual orientation. LGBTQ+ youth are 3-5 times more likely to attempt suicide.

Recognizing the importance of the issue, the
Wisconsin Department of Public Instruction awarded over $6 million in grants to help WI schools with mental health services.

Teachers and all other school personnel who interact with students on a daily basis can play a vital role in identifying those at risk and prevent potential tragedies. As providers, we can play an important role by routinely screening for depression during back-to-school wellness and sports physicals. We can also work with teachers, school counselors and private therapists as part of an inter-professional approach to the student.

Below are a few resources you can have available to parents and school personnel regarding depression and suicide prevention.

Resources for parents, from the American Academy of Pediatrics:
Resources for school officials, from the Suicide Prevention Resource Center:
Resources for providers, practice guideline for adolescent depression:


Advocacy Central
Where are we on the CARES Act?
If you can help WAPA build support for the Collaboration and Rural Expansion of Services (CARES) Act by meeting with your local representatives, please email Melissa Graham or Paige Scobee -- every single PA's voice matters!

The legislature is not likely to reconvene for floor sessions until October, at the earliest. Some committee work will continue into the fall and WAPA is aiming to introduce the CARES bill this fall as well!

We need to continue meeting with senators and representatives around the state to build support. Please help us connect with the following: Rep. Tony Kurtz (R) in Womewoc, Rep. Jesse Rodriguez (R) in Oak Creek, Rep. Chuck Wichgers (R) in Muskego, Rep. Gae Magnifici (R) in Dreser, Sen. Tim Carpenter (D) in Milwaukee, Rep. Daniel Riemer (D) in Milwaukee, Rep. Jimmy Anderson (D) in Fitchburg, Sen. Andre Jacque (R) in DePere, Rep. Chris Taylor (D) in Madison, Rep. Nancy VanderMeer (R) in Tomah.

WAPA member Jennifer Black, PA-C, is pictured here after a recent meeting with Rep. Felzkowski. Thank you, Jen!
Wisconsin Legislative Updates
Dental Therapists – Rep. Mary Felzkowski (R-Irma) and Sen. David Craig (R-Big Bend) have introduced legislation (SB 89/AB 81) that would create a new license under the Dental Examining Board for "dental therapists," an intermediate level of dentistry practice between hygienists and dentists. Similar legislation failed to pass last session, due primarily to opposition from the Wisconsin Dental Association. At an Aug. 21 public hearing, a coalition of around 60 groups testified or registered in support of the bill. The Wisconsin Dental Association strongly opposed the bill.

Loan Assistance Sens  Sens. Alberta Darling (R-River Hills) and Janet Bewley (D-Mason) and Reps. Mary Felzkowski (R-Irma), Daniel Riemer (D-Milwaukee) and Jeremy Thiesfeldt (R-Fond du Lac) introduced legislation, AB 178/SB 166, that would expand the health care provider loan assistance program. The Senate Committee on Universities, Technical Colleges, Children & Families held a public hearing on Aug. 27. WAPA is registered in support of this legislation.

Direct Primary Care Earlier this summer, the Senate Committee on Health & Human Services held a public hearing on SB 28, related to Direct Primary Care. The Assembly Committee on Small Business Development held a hearing on Sept. 4. WAPA is registered in support of the legislation.
  • SB 28 does not include the MA pilot program or work group.
  • SB 28 changes the agreement to provide Primary Care Services instead of Routine Health Care Services.
  • SB 28 specifies the fee for DPC is a subscription fee.
  • SB 28 includes the same list of providers, but specifies they must provide primary care under their own scope of practice.
  • SB 28 provides a longer and broader list of services that may be provided under DPC.
  • SB 28 includes a provision clarifying the authority of DSPS and DATCP to regulate agreements.
We are WAPA
Message from the President
Advocacy: Unseen and Unheard, but Felt, by Every PA in the State

When I became a PA in 1994, every single one of my notes required co-signature by a physician within 24 hours. I couldn’t prescribe scheduled medications. I couldn’t even order physical therapy. That isn’t true today. Why?

From early on, positive changes to our rules and regulations, Chapter Med 8, have all been initiated by WAPA. This is the only organization in Wisconsin that has the best interests of the PA profession in mind and whose sole purpose is our viability and advancement within the state. Let’s take a look at some of the legislative changes that WAPA has spearheaded over the years.

Chapter Med 8 became ours in 1976. In those days, there were a handful of PAs in the state and WAPA was called WISPA. We could prepare prescriptions but could not sign them. We were truly considered assistants and our title carried the dreaded apostrophe.

Things began to change in the 1980’s and early 90’s when WAPA was represented at the Capitol by one or two PAs who served as our registered lobbyists. These were forward thinking PAs who gave of their time and their own money to advance our profession. Thanks to their work during that time, PAs became able to sign prescriptions and some orders. The caveat was that our progress notes had to be cosigned within 24 hours in lieu of an actual signature on those prescriptions or orders. This was later changed to 72 hours.

Around the time of my graduation, our title changed as well. We went from physician’s assistant to physician assistant. In the late 90’s, PAs were granted the ability to prescribe controlled substances Wisconsin. Nationally, we were allowed to obtain a DEA license as well as NPI numbers.

By 2010, WAPA representatives had completed their work with the MEB to eliminate the prescription co-signature requirement altogether. Instead, PAs were required to maintain a prescribing protocol subject to annual review. Other advancements around that same time included the ability to order physical therapy and to sign certain forms. And in 2014, WAPA worked with the MEB to change the physician-PA ratio requirement from 1:2 to 1:4.

The above changes were hard fought by a dedicated group of PAs within WAPA who worked tirelessly with the MEB to ease the administrative burdens of PAs. But after meeting frequent obstacles, and seeing that our regulatory burden led to preferential hiring of other providers over PAs, WAPA realized that new strategies were necessary. It was determined that legislative changes, rather than rules changes, were needed to protect and advance our profession. Thus, the CARES Act was developed. In the coming weeks, this culmination of 3+ years of hard work will be introduced to the Wisconsin legislature.

CARES stands for Collaboration and Rural Expansion of Services. This legislation will make sweeping changes to the regulation of PAs in Wisconsin. While our day to day interactions with our physician colleagues will not change, our relationship will now be described as collaborative rather than supervised. Our scope of practice within our specialty will be determined by our own education, training, and experience rather than depend upon that of the physician whose name is attached to our license. We will be recognized as billable providers who can receive direct payment. We will be allowed be self-employed (1099 employee). And, very importantly, we will regulate our own profession. It is my firm belief that all of these changes are necessary for the PA profession to remain viable in this state. I urge you to learn more about CARES at or

As always, I am available to answer any members’ questions. Please email me at

Respectfully submitted,

Julie Doyle, PA-C
WAPA President

PAs Who Hustle Hard: Meet the Next Generation!
From didactic years to clinical rotations for Concordia students
Submitted by Erin Hannigan
The Concordia PA Program welcomed the class of 2021 back in May. They have since completed their first semester and voted in their class board which is pictured here. We are excited to have them on campus as they jumped further into didactic year on August 26.

The class of 2020 is also pictured on the bluff here at Concordia on one of their last days of didactic year.  We started clinical rotations on August 26 and are all excited to continue learning from our awesome preceptors!
New and exciting changes happening at Marquette’s PA Program
Submitted by Sarah Hoffman and Jaclyn Goble
We are kicking off the semester in our new building, which has afforded us the opportunity to welcome 3 new faculty and accept an additional 20 students. Our Open House on October 5 will show off our new space to alumni, preceptors and MU community.

  • We welcomed 75 new students to campus at the end of August. Nearly half of these students are from Wisconsin, but some come from as far as Rhode Island and California.
  • The PA-2s just finished up a rewarding summer semester and are excited for new medicine courses and to continue clinical experiences at homeless outreach clinics.
Open House at Carroll University and new partnership with St. Joseph
Carroll University's graduate studies open house will be on Wednesday, October 9 at 6 pm. We are also excited to deepen our partnership with St. Joseph's Medical Clinic. In April, 2019, we announced renovations to a 9,000-square-foot building which will be shared by both organizations. In the future, PA faculty and students will provide medical services through the free clinic to underserved communities -- it's a good time to be a Pioneer!
Largest class to date for UW-La Crosse PA Program
Submitted by Matt Zamzow
The UWL physician assistant class is going back to school following Labor Day after having finished up its first semester in early August. The class of 2021 is the largest class for the program thus far, and we are trying out a lot of new projects along the way. UWL has also recently added a third clinical partner, Marshfield Clinic, to the program and is excited to strengthen that partnership in the years to come. One of our first volunteer events with Gundersen Health Systems and other local businesses in September is the "Steppin’ Out in Pink" benefit walk to support local breast cancer survivors and research.
Last days of summer for UW-Madison students
Submitted by Jennifer Lynn Lamba
The UW Madison PA Program Class of 2021 and Distance Class of 2022 finished their first summer semester this past month. It was a time of learning, a time of making new friends and a time of dreams coming true! There is nothing like making it through Anatomy to bring people together!
For the PA Today
As a physician, how many PAs can I collaborate with at a time? What if I need to add members to my team? Keep calling (414) 253-8188 or emailing WAPA with your practice questions!

The DSPS Medical Examining Board limits supervisory agreements to four PAs, but does not specify part-time or full-time PAs. We interpret this to mean four individual PAs at one time (as an example, four per shift). Also note, a PA may be supervised by more than one physician while on duty.

Furthermore, Chapter Med 8 (section 10) says no physician or podiatrist may supervise more than four on-duty physician assistants at any time unless a written plan to do so has been submitted to and approved by the Medical Examining Board.

And, of course, nothing there are no limits to the number of physician assistants for whom a physician or podiatrist may provide supervision over the course of their careers.

PS This is a great reason for physicians and hospital systems to submit a letter of support for the CARES Act. Here's a template you can use and we have other templates for letters of support from different staff types, too.

Upcoming Events
WAPA's Great Midwestern Medical Conference
October 23-25, 2019
American Club in Kohler, WI

It's easy to register for WAPA's Great Midwestern Medical Conference. Register online or call us at (414) 253-8188.

We'll be offering a hands-on suturing workshop, but pre-registration is required. Cost to register is $70. We are teaching basic and advanced tips on suture types and selection, proper loading of the needle, wound assessment, local
anesthesia and aftercare. Attendees can practice hand-tie knots, subcuticular running, mattress stitch, corner stitch, buried stitch and securing tubes. The first session will be on Thursday, October 24, at 8-10:00 am and a repeating session is at 1:30 pm.

Feel free to explore the preliminary program online and tell your colleagues about it. PAs are always welcome and we're inviting our RN partners, too!

9/11/2019 » 9/13/2019
Location: Rochester, Minnesota   

3rd Annual Hematology, Oncology & Blood & Marrow Transplant for NPs & PA
9/13/2019 » 9/15/2019
Location: Rochester, Minnesota   

SPOTS Series

Location: Pewaukee, Wisconsin  

Inpatient Medicine for NPs & PAs: Hospital Medicine from Admission to Discharge
10/16/2019 » 10/19/2019
Location: FERNANDINA BEACH, Florida    

2019 WAPA Fall Great Midwestern Conference
10/23/2019 » 10/25/2019
Location: Kohler, Wisconsin   

Top Jobs from the WAPA Career Center
Looking for ways to get your job opening noticed? Head on over to the WAPA Career Center to advertise your positions with WAPA members. Members can search this job board for free.

Glenwood, Minnesota

Oshkosh and Sheboygan Markets, Wisconsin

Waukesha, Wisconsin

Physician Assistant
Viroqua, Wisconsin
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