Rural care: How a small-town PA found a niche career
“Physician extenders” — such as physician assistants and nurse practitioners — have proved their worth to health care, especially in small towns and rural areas, where doctors are often scarce.
“Doctors have found out that there is value in having PAs and NPs available. In a rural area, the biggest problem is trying to see all the patients, so if you have a PA or NP that can help you function, you can almost double the amount of patients you care for,” says Gary Engle, a PA at the South Lewis Health Center in Lyons Falls, a family practice satellite clinic of Lowville‘s Lewis County General Hospital.
Engle, 67, grew up in rural Madison County and got into medicine when PAs and NPs were just becoming a reality, more than 40 years ago.
For his work as a voluntary PA trainer, he was honored with a President‘s Award for outstanding service to the Upstate College of Health Professions.
Engle, who plans to retire this spring, spoke recently about being a rural PA.
Upstate Health: You got a nursing degree from Morrisville College. What made you go from nursing to the new specialty of physician assistant?
Engle: “I was working as a night supervisor at Community Memorial Hospital (in Hamilton), and I worked with a couple of PAs. It looked like something I would enjoy doing and could do with proper training. That was back when we were just getting into this concept of somebody who could do a lot of what doctors do but weren‘t really doctors.”
After you got your PA degree, in 1977, where was your first PA job?
“I ended up in Lewis County General, in the emergency room for the first several years, where the ER was literally one room — the nurse had one chair, and when I worked, I stole her chair. I was the provider in the ER, with the attending staff (doctors) backing me up, so if I needed a surgeon, I called the on-call surgeon. But most of the stuff I could handle, with a doctor reviewing the chart later.
“Prior to my being there, a doctor would have to leave office patients, go see a patient in the ER, then go back to the office.”
You have worked in both hospital and office settings in Lowville, Carthage, Boonville, Watertown and, for the past 10 years, Lyons Falls. What do you like about working in a small town or the country?
“I grew up in Madison (a village in eastern Madison County) — basically a crossroads, where we jokingly said, ‘You‘re entering Madison‘ was written on both sides of the same sign. I do like a rural area, a small town, with friendly people. I feel like I‘ve gotten to know my patients. I have some four-generation families I take care of.
“I think you can be an individual here, not that you can‘t in other places, but people come to see me because they want to see me. In a lot of other areas, you‘re just one of the PAs there.
“The need for PAs in rural areas has been there for a long time.”
Have patients ever balked at seeing a PA instead of a doctor?
“At the start, there was some mistrust, but the vast majority of people get over the mistrust in the first few minutes. I‘ve always tried to treat people respectfully. I remember a 9-year-old boy having an asthma attack, and I was told he was the son of the president of the hospital board of managers. I felt a momentary sense of panic, and then I thought, ‘I treat everybody like they‘re the son of the president of the hospital board of managers,‘ and people respond to that.”
What is it like to work as a preceptor, or trainer, of aspiring PAs?
“I learn as much from them as they learn from me. My patients love them. After 40 years, there are mornings when I get out of bed and say to myself, ‘I don‘t want to listen to Mrs. Jones talk about her gout,‘ and the student will say, ‘Hey, we get to see a lady with gout!‘ So, it changes the way I look at things. When you have these young professionals come here, they‘re excited, and it reminds me what my attitude should be.
“When I got this award for being a volunteer, I remember what my dad said when I was 8, explaining why he volunteered with the fire department. ‘We‘re in a small town, so it‘s up to everyone who can to volunteer.‘”
This article appears in the spring 2018 issue of Upstate Health magazine.