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MediPreneurs: Oncology/Hematology Physician Assistant

-Tracy Webb

-Tracy Webb

In this MediPreneurs profile, PharmPsych.com decided to feature Tracy Webb, PA-C, Compass Oncology/Hematology Physician Assistant with the Oregon Area Hospital and Health Care and Washington state health care systems in both Portland and Vancouver.

Webb has clinical interests in breast cancer, heme malignancies and survivorship, being board-certified as a NCCPA Physician Assistant, having obtaining her master of science degree in physician assistant studies from Philadelphia University in 2010 and a bachelor of science degree in kinesiology of the University of Maryland in 1997 and having performed some coursework at the University of North Carolina at Wilmington between 1992 and 1994. [The NCCPA is the National Commission on Certification of Physician Assistants.]

Since October 2010 in her capacity with the Oregon and Washington state medical systems, Webb says that she is a “ … mid-level provider on a great medical oncology team and see patients with [predominately] breast, colon and heme malignancies … ”

Over the past five years, she has treated her patients “ … during active treatment and in routine follow-up …” Webb also says that she has “… the opportunity to meet with patients to focus on their issues related to survivorship, including: anxiety over recurrence, depression, fatigue, neuropathy, cognitive changes and issues of intimacy …”

Prior to moving to the Oregon and Washington state areas, Webb, a Temple, Md. native who has family and relatives in Florida she visits routinely, lived in the greater Washington, D.C. area in the 1990s and the millennium where she served as a technical proposal writer for Blue Cross/Blue Shield Association insurance company.

Later, she was proposal manager with Altos Federal Group, a minority-woman-owned medical staffing government contractor in Silver Spring, Md., and, as a result, supervised this author who, then, was a technical proposal writer for the company. Having moved from Maryland to Annandale, Va., it was during this stint that Webb began and completed her physician assistant studies with Philadelphia University.

There and then, she divided her time between work, study, visiting such states as Alaska for running, hiking and kayaking and playing with her nieces and nephews in Florida when she could fly over and visit.

Today, Webb divides her time between her physician assistant work, her son, Lucas, aged 1, her husband, Morgan, a police officer in the Portland area and occasional activity in the great outdoors.

The following is an Sept. 11 and Sept 12, 2014 e-mail exchange between PharmPsych.com and Webb when she was on a plane trip for her sister’s wedding in Florida:

1. You have worked in different capacities before you became a Physician Assistant. As we both know, you were my proposal manager at Altos Federal Group in Silver Spring, Md. while I was a proposal writer. Before that, you were a proposal writer and manager at Blue Cross, Blue Shield in the greater Washington, D.C. area.

What is it that inspired you to enter the field of medicine? Had you always wanted to do it and could not afford to go to medical school at the time? Or did you decide on it later? And, if so, when, where and why? Were you inspired by your work with Blue Cross, Blue Shield or other companies you worked for? If so, how and why? Were you inspired by a member of a family or friends? If so, how and why?

In particular, why did you choose to become a Physician Assistant, of all the medical occupations you could have considered? And why oncology? Why did you choose the school in Philadelphia to study? What did they provide that the others did not, in either case? What degrees did you obtain?

I went into medicine as a career field because I’ve always been fascinated by it – by our health, our illness, and recovery.

When my father became ill with a virtually incurable cancer — mesothelioma — despite being a marathoner and avid cyclist, I started the process of preparing to change careers to become a physician assistant.

I opted for this path instead of medical schools, internship, and residency because I was already 35, wanted to be able to start practicing relatively quickly, and still have time to have a child.

I needed to re-take my core science courses from undergrad as physician assistant programs limit pre-reps to having been completed within the past seven years in many cases. Then, with those completed, I applied for a master’s degree in physician assistant studies. Being a physician assistant allows me to see and treat patients as a medical provider. I don’t see any downside to my decision.

2. You were a native of Florida, correct? Did you study there? You also lived in Annandale, Virginia and visited Alaska often. Did you study there, too? What did you study at the University of Maryland and of North Carolina? Did you use what you studied? Did you graduate? What degrees did you obtain? How have those skills helped you?

I’m originally from Temple Hills, Md. I graduated from the University of Maryland with a bachelor’s degree in kinesiology.

3. In your Linkedln profile, you describe your work as a mid-level provider on a great oncology team to see patients with “breast, colon and heme malignancies.” You care for them “during active treatment and follow up over five years.” You “also meet with them over survivorship such as anxiety, recurrence, depression, fatigue, neuropathy, cognitive, intimacy and other life changes.” Exactly which clinic, department, ward and which hospital do you work in? Do you work in the state of Oregon health care system? Did you actively choose to work there or did you prefer another medical setting? If so, why?

Does “heme” refer to “hematology”? If not, what does it mean? Active treatment refers to radiation treatment and chemotherapy, right? Am I missing another aspect of treatment? Does it vary with the type of cancer? In terms of follow up over five years, the cancer patients are made to attend annual checkups to the hospital every year to make sure they are cancer-free. Is that right?

How do you help them resolve issues of survivorship? Give a few examples.

I’m a physician assistant with Compass Oncology in Vancouver, Wash. and Portland, Ore. We are a group of community-based cancer centers.

I work with Dr. Magdolna Solti, seeing primarily patients with breast cancer, some hematologic malignancies, some non-cancerous heme patients and a few other solid tumors, such as colorectal cancer. I actively sought to work with Dr. Solti because she is well-known for her intelligent, compassionate care.  She and I try to alternate visits with our patients every other visit during their five years of intensive followup.

These are a cluster of issues that are important to address during and after treatment, including: fatigue, nutrition/exercise, cognitive changes, anxiety over risk of recurrence, depression and issues with intimacy.

As providers, it’s wise for us to bring these issues up with our patients so we can have conversations about issues that could really be long-lasting and impactful. For example, fatigue related to treatment is reported up to seven years later, if untreated. Fatigue is one of those multi-factorial issues.

After correcting for medical causes such as anemia, which might have developed during treatment, sleep apnea, or thyroid disorders, we generally make several recommendations.

First, we encourage starting an exercise program because this is the most effective way to diminish fatigue and improve energy based on survivorship studies. We recommend starting slowly even as little as 15 to 20 minutes per day four times per week and increasing gradually over eight weeks to the American Cancer Society’s minimum target of 150 minutes per week.

Next, we address sleep.  For patients who aren’t sleeping well or enough at night, we recommend following sound sleep hygiene, which includes going to bed at roughly the same time each night and making time to wind down in the hour before sleep in which you turn off the TV or computer, take a warm bath and perhaps even use a 10-minute relaxation or guided meditation to help prepare for sleep.

If one isn’t sleeping within 15 to 20 minutes, we recommend getting up and tackling non-stimulating chores until you are feeling ready for sleep. Then go back to bed.  When one finally does get to sleep, awake at roughly the same time each day no matter how tired you may be.

Limit daily amount napping to one hour or less to promote sleep the next night. Save your bed for sleeping or romance only – no TV or reading. We also suggest limiting caffeine to 1 to 2 cups of coffee daily.

If this fails after several consistent weeks, some clinicians may recommend a sleep aid. Others recommend seeing a sleep specialist.

Nighttime rest is important. With fatigue, we also address anxiety and distress. Often, folks suffering from anxiety or depression find it difficult to get to sleep or find that, when they wake up in the middle of the night, circuitous thoughts take over and they can’t get back to sleep.

We recommend they keep a bedside notebook so they can note what’s on their mind and let it go until the morning. We also strongly encourage counseling to help address their underlying concerns.

4. What is the most uplifting case you have ever had working with cancer patients and their families? What made it rewarding? How did you handle it? Give me an example.

Most uplifting story – I don’t have any great ones that stick out, but I have to say that working with men and women living with cancer is very inspiring and perspective-shifting.

They often arrive, newly diagnosed and, understandably, quite anxious and upset.  Life, as they knew it, gets upended. Everything is affected – work, finances, relationships, social life and hobbies. However, often out of necessity, they find good coping skills and adjust quite amazingly. Others, through sharing their concerns with us, can be connected to our resources or resources in the community to help them cope better. It is a blessing to see people put one foot in front of the other through adversity every day.  Resilience is admired and inspires others.  Working with our patients is quite rewarding.

5. What is your relationship with the oncology team? What are the different medical titles or occupations in the oncology team and what role do they play? Is the clinic, ward, department or hospital exceptional in oncology as a medical specialty? Please explain.

Teamwork – I work collaboratively as part of a multidisciplinary team involving our breast surgeon, my supervising physician who is a medical oncologist specializing in breast cancer, radiation oncologists, myself as a medical oncology physician assistant, nurses, and our social worker as well as our huge-hearted support staff.

We work together in our community-based cancer center. When someone is diagnosed with breast cancer, they generally are first sent to a breast surgeon (we have two terrific ones on our team, Dr. Toni Storm-Dickeron and Dr. Tammy De la Melena). From there, they are referred to us in medical oncology to determine whether or not chemotherapy, radiation, or both are needed.

We also assess whether or not anti-hormonal therapy is needed. We refer to our radiation oncologists on staff when radiation may be indicated. My supervising physician and I alternate visits with our shared patients every other visit.

6. Walk me through a typical day in your work setting. What do you do first? What do you do in the middle? What do you do last? What time does work start? What time does it end? Are you on call? If so, do you have a specialized cell phone or mobile phone or technology you use in medical settings? Are there overtime hours? Give me more detail. Is there not such a thing as a typical day? Are some days slower than others?

A typical day starts at 7 a.m. or 7:30 a.m. doing rounds on our patients who are in the hospital. Afterwards, I start my day in the clinic at 9 a.m. seeing patients in 30 -minute office visits until 5. Like all providers, between visits, at lunch, and after hours, I dictate notes on patients, review labs and scans, make phone calls to patients or their other medical providers.

7. What do you like best about your job? What do you like least about your job? How are the pay and the compensation package?

Working as an oncology PA is especially rewarding. Not only do I get to work with a very sharp and caring group of professionals but I have the great privilege of taking care of patients at a vulnerable time.  

In our visits, pretense is stripped away. What matters most to patients is right on the surface. I appreciate the honesty of their struggles and the candor with which they share. I feel like I truly have an opportunity to connect, to teach and empathize.

With cancer, patients want to do everything in their power to get better. They ask great questions, they seek legitimate information and try their best to take an active role in the process. I really feel trusted and know that my interaction with a patient on the day of their visit can matter and make a difference to them.

8. Do you like working in the public sector? Is loan forgiveness part of the picture? Would you prefer a private setting? If so, where and why? Has the Great Recession affected the functionality of your employer and your own work? If so, how?

I enjoy working in our setting.  Loan forgiveness is not part of the picture, but I am fortunate not to have a debt. There are many PA positions that do offer loan forgiveness, however.

9. You live in Portland, Ore. Is that right? Did you once live in Seattle, Wash.? What made you move — your work? If you did live in Seattle before, how far is it from Portland, Ore.? Do you drive to work? How is the drive?

I live in the Portland area and commute to Vancouver, Wash. and into the city of Portland for work.  The commute is easily 30 to 40 minutes at peak traffic.  Much better than my commute in the D.C. area!

10. Why did you choose to live in Portland or Seattle? What do you love about it?

I chose to live in Portland because it is an outdoors person’s dream. There are so many forested trails to run, hikes to explore in the Columbia River gorge or on Mt. Hood. Excellent rivers for kayaking.  It has a really mild summer, which is perfect for the activities I most enjoy. I have stayed for those reasons and more.  I met my husband here. 🙂

11. A child has entered the picture. Tell me about him, the little baby. Aside from love and spiritual fulfillment, does he inspire your work in any way?

Lucas, my 1-year-old, really is our pride and joy. He is THE reason my husband, Morgan, and I continue to do what we do on a daily basis.

My husband is a police officer and works to keep people safe on our rivers.  Providing for the safety of the community is everyone’s responsibility and he truly leads conscientiously by example.

As a PA, I really try to make a difference to our patients by treating them with the care I would want my own family and friends to receive in their time of need.

By showing people that we care, we make someone’s journey a little easier. By taking the time to teach someone when asked, we demystify the scary things. By being willing to laugh with a patient or make gentle contact with someone who needs it, we level the field and humanize ourselves.

When people are treated this way, they may want to treat others this way, too.  That is why I want to be present for my son as he grows up and face struggles normal in the human condition.

12. In terms of your career as a Physician Assistant, where do you see yourself five years from now? Ten years from now? Be specific.

In the future, I see myself continuing to practice in my current role. Of course, I plan to continue my education to stay abreast of all of the advances in oncology care. As I learn more, I’d love to be a leader in our community-based practice to help teach our newer providers. But, I’m not sure I’d ever be prepared to NOT see patients.  That’s my calling.

13. What advice would you give college graduates entering your field and your professional peers in terms of their approach to their medical work?

Advice to new grads – I think most folks in medicine are here because they push themselves hard.  With that said, I think it’s far more important to find an area of medicine that you are passionate about and feel well suited to, than one that pays better. You really shine when you are in your wheelhouse. Long days aren’t such a drag when your heart is full. Reimbursement comes in many forms.

NOTE: (PharmPsych.com offers up MediPreneurs, a news series featuring medical professionals and allied health employees of all specialties, especially the field of pharmacy. MediPreneurs are leaders and managers in a variety of medical fields who often use their talents to start their private practices or businesses or challenge themselves to transform and improve community health as board members, group founders, mentors or college professors. Our MediPreneurs series seeks to draw on and explore the expertise and experience of these medical heroes and put them in the public spotlight, one professional at a time.)

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Last updated September 2014Tracy Webb pic

 

 

 

Vladimire Herard, M.S. (99 Posts)

A print journalist for 21 years, Vladimire Herard freelanced for the National Senior Living Providers Network, (nslpn.com), the Guidance Channel and Longtermcare.com. Under CD Publications, Ms. Herard wrote about senior health, substance abuse prevention, and elderly housing. Under Inside Washington Publishers, she covered health care financing for Inside HCFA and food and product safety issues for FDAWeek. Ms. Herard also covered education, crime, and county affairs for daily newspapers such as the Chicago Defender. She currently covers senior long-term care, the pharmaceutical industry and issues and education. Ms. Herard resides in Chicago.


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