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Music during surgery: Just what the doctor ordered

Three Surgeons Operating On A Patient

This article is reprinted with permission from WABE.

The last patient of the day lies on the operating table of Dr. Kenneth Neufeld. Time to play some hip-hop.

“Oftentimes we change the music at the end of the day to give every one in the room a little bit of an energizing boost just to get through the last case or two,” he says.

Dr. Kenneth Neufeld

Dr. Kenneth Neufeld

Neufeld is a plastic surgeon for eyes at the Thomas Eye Group in Atlanta. On this day, he reconstructed a woman’s eyelid that was destroyed by cancer; removed a metal piece from a little boy’s eye socket after a shooting accident; and performed a few cosmetic eyelid lifts.

No matter how complicated the surgery, he always plays music. Sometimes, he says with a wink, he even plays hip-hop, but his favorite is ’80s pop.

“To me the music in the room is more for the environment,” he says, “to keep everyone involved in patients’ care in good spirits and functioning well, such that we can deal with the surgery efficiently and safely and keep the flow going.”


Specialists and their special tunes

A new research project, jointly conducted by German and American doctors, has found that more than 70 percent of all physicians listen to music in the operating room, via MP3 player or Internet streaming. Music, many doctors say, helps them focus and perform better.

The study, which hasn’t been published yet, also looks at preferences. Dr. Claudius Conrad is one of the lead authors.

“We saw surprising differences,” Conrad says. “And that has to do with the roles of anesthesiologists and surgeons in the operating room.”

Conrad is a liver surgeon at MD Anderson Cancer Center in Houston, Texas. He says anesthesiologists need to monitor alarms and pay attention to acoustic signals.

“We found that anesthesiologists prefer classical music and jazz music, whereas surgeons, their task is very different, a motor performance over prolonged periods of time, and that leads them to need more activating music to have more endurance.”

For Conrad, music and medicine are closely intertwined. Born in Munich, Germany, he holds doctorates in medicine and music philosophy.

At times, the study says there are conflicts between surgeons and anesthesiologists in the OR about the music, be it the genre or the volume.

Dr, Marcel Gilli

Dr, Marcel Gilli

“Some docs, they play their music really loud. That sometimes is rather a distraction,” says Dr. Marcel Gilli, an anesthesiologist at Piedmont Hospital. “The second thing is, the type of music is not always agreeable to everybody. I’ve even witnessed a surgeon who plays Christmas music in June.”

Born and trained in Switzerland, Gilli has practiced medicine in the United States for 30 years. He says he likes a strict routine in the operating room.

“When I put a patient asleep, I want it to be quiet in the operating room. I don’t want a lot of music, and if it’s music, then just background music.”

When doctors disagree

Gilli says most patients, as they are wheeled into the OR and the medicine kicks in, also prefer softer tunes. Once the patients are out, and during the procedure itself, the music usually doesn’t bother him, he says. And if it does, he asks his colleagues to push the pause button.

“Surgery still is a very serious business,” Gilli says. “You have to be vigilant every single moment.”

Eye surgeon Neufeld agrees. But to him personally, music is not a distraction, even in critical situations. He simply blocks it out.


“To me, sometimes, it’s more like white noise,” he says. “Often times, I lose myself in the surgery, and I have no idea what’s going on with the music on the outside. I’m just intent upon the task at hand, and I focus internally as opposed to exerting a change in the external environment.”

Despite all differences, research shows that in the operating room, music synchronizes the work flow, fosters communication and improves performance. Study author Conrad thinks classical music is a good bonding agent in the OR.

“We have looked at finding an easy common denominator,” he says. “And we found that classical music seems to work the best for most people.”

Whether it’s classical or pop, Christmas carols or hip-hop, the final decision about the music always lies with the surgeon. And so does the responsibility to achieve the best possible outcome for the patients, says Neufeld.

“If the surgeon is frazzled, it trickles down and everyone gets frazzled. And I think a big part of being a surgeon is keeping your composure and keeping everyone else in the room as focused on the task as you can.”

On this day, no one got frazzled in Neufeld’s operating room. The last suture is done, the last song played.

Katja Ridderbusch is an Atlanta-based independent producer for German National Public Radio. She is a senior foreign correspondent for Die Welt and Der Tagesspiegel, as well as Spiegel online. She frequently reports about health care in the U.S.

Food for thought: What future doctors are learning about nutrition

The Athens medical students are taught to consider diet in the context of income and access to medical advice

The Athens medical students are taught to consider diet in the context of income and access to medical advice

If you type the phrase “What do doctors know about nutrition?” into an Internet search engine, the most common result will be “not much.”

Some links will open on articles claiming that busy doctors have no time for diet advice during brief office visits. Other will lead to authors who chastise medical educators for drilling students on neurology at the expense of nutrition.

The National Academy of Sciences recommends that medical students get at least 25 hours of instruction about nutrition. Even though this advice comes from a highly respected group, the fact is that only 30 U.S. medical schools — roughly 25 percent of the national total — actually follow it.

At the new medical campus in Athens, Dean Barbara Schuster’s faculty has chosen a different route from what is supposed to be the norm on nutritional instruction. It’s not focused on devoting hours to formal nutrition courses.

She says the “case-based” approach used at Georgia Regents University-University of Georgia Medical Partnership (GRU-UGA) teaches students how to build nutritional considerations into treatment plans for their patients.

YouTube Preview ImageDr. Schuster freely acknowledges that the school offers no freestanding courses on nutrition, but this does not trouble her. She resists the idea that nutrition is something to be taught in isolation.

Information about what constitutes healthy or unhealthy eating, and how nutrients can promote health and healing, is abundant in the school’s curriculum, she says. It’s incorporated into lectures, discussions and problem-solving exercises.

“We integrate all the information within our case-based structure,” Schuster said. “Elements of nutrition really are added across the curriculum into the cases.”

During a biochemistry learning module, for example, students might be required to examine a runner’s metabolism.  They would analyze the athlete’s energy needs and consider how different types and quantities of foods could meets those needs. They’d work out how foods are transformed into energy, calculating how many calories the runner needs based on his or her body weight.

A practical approach to obesity

Knowledge about nutrition becomes even more important in the third year of medical schools, when students begin clinical rotations that take them into hospitals and doctors’ offices.

A student on a surgical track may need to look at the food intake of a patient recovering from an operation, with the goal of restoring normal metabolism as soon as possible. Those focusing on family medicine may see patients who have been obese for years, and the medical student may wrestle with the challenge of providing effective counseling in an office setting.

More than 78 million Americans face the life-threatening problem of obesity, and the rates are highest in the South.

Schuster’s philosophy, of course, is not to look at the problem in isolation.

What families choose to eat often depends on what they can afford. The Athens medical students are taught to consider diet in the context of a patient’s income and access to medical advice, two key factors in obesity. The students learn to take all these factors into consideration when calculating treatment plans for temporary illness, injury or chronic disease.

“We really try to intermingle aspects of poverty and a lack of medical care into the curriculum as well,” said Shuster. This is important because students learn to understand how complex a person’s overall well-being really is.


When researchers at the University of North Carolina at Chapel Hill examined trends in nutrition education at U.S. medical schools, they found that the number of hours usually falls short of the National Academy of Sciences recommendation. And the number of hours is actually dropping.

But hour totals are not necessarily an indication of how well the subject is being taught. In Athens, for instance, the case-based learning methods of the Medical Partnership are an “excellent way to integrate nutrition into medical education,” according to Dr. Mary Ann Johnson, a foods and nutrition professor at UGA and a national spokewoman for the American Society for Nutrition.

Johnson believes national guidelines can encourage medical schools to integrate nutrition education into their teaching, and she says technology is also changing the landscape as doctors use mobile devices to supplement their own memories.

“Health professionals should know where to access nutrition education and advocacy resources and should use innovative approaches, including online resources and case-based approaches to enhance learning,” she says.

Johnson believes that integrating learning about food, diet and nutrition into standard medical instruction is more important than setting aside a certain number of hours for nutrition classes.

This is what Schuster hopes that graduates of the GRU-UGA Medical Partnership will remember a decade from now, when they have their own patients to care for.

“Students may not have taken courses on food, but we’ve put all those areas of nutrition in throughout the curriculum just like everything else, so it’s not separate,” she says.


Katie Ball is a medical journalist based in Athens.  Recently earning her graduate degree in health and medical journalism from the University of Georgia, her writing interests include food and nutrition, health policy, and medical technology. 

Medicaid physicians back in same spot after long-awaited raise expires

Dr. Jaquelin Gotlieb examines a new patient, Jada Smith, 5, at her Stone Mountain office

Dr. Jaquelin Gotlieb, shown examining a patient, says that the Medicaid pay bump is a matter of valuing children.

Dr. Michelle Zeanah is getting a big pay cut this month.

It’s not that the Statesboro pediatrician is seeing fewer patients. Just the opposite.

The 12 rural counties surrounding Bulloch County, where Statesboro is located, have no pediatrician. So Zeanah is very much in demand.

Forty percent of her patients have driving distances of 45 minutes or more. A few come from more than 50 miles away.

Dr. Michelle Zeanah

Dr. Michelle Zeanah

Her pay cut involves the Medicaid program. Reimbursements to primary care doctors under Medicaid just went down in Georgia and many other states.

The Affordable Care Act had awarded primary care doctors treating Medicaid patients a two-year pay increase. It was funded entirely with federal money, and pushed their Medicaid pay to the level of Medicare reimbursement.

But that additional Medicaid reimbursement, which went to family physicians, pediatricians and internists, ended Jan. 1. And doctors will be missing it.

“It allowed us to hire more staff so we could serve more patients,’’ Zeanah says. Without it, she adds, “I will have to work 70 hours a week’’ instead of the current 60.

About 70 percent of her patients are covered by Medicaid or PeachCare (the Georgia version of the child health insurance program).

Medicaid, the federal/state program for the poor and disabled, serves more than 1.5 million Georgians. Most are children.

Before the increase, Georgia primary care doctors had gone more than a dozen years since the last Medicaid pay hike.

A few states, including Alabama and Mississippi, have continued giving their primary care doctors the pay hike by using state dollars to fund it.

But Georgia political leaders, on the eve of the 2015 General Assembly, have shown no signs they’ll appropriate money to reinstate the pay hike. The money that would be needed – an estimated $62 million for a year – is not in the Department of Community Health budget being proposed to Gov. Nathan Deal.

Sasha Dlugolenski, a spokeswoman for the governor, said in an email to GHN in September that Deal was aware of the issue. She called the pay hike expiration “one of the early, blatantly obvious examples of Obamacare unloading costs onto the states. This was a short-term Band-Aid to a long-term problem, and now the states are left holding the bag.”

The federal health law required that the raise be paid for two years, 2013 and 2014. The money actually did not arrive till 2014, but when it did, eligible doctors received the pay hike retroactively to Jan. 1, 2013.

Such delays in the payments occurred in many states, including Georgia, that use managed care in their Medicaid programs.

Practices feel the pinch

The end of the federally funded raise means that Medicaid fees in Georgia will now be reduced by 34.8 percent, according to a recent Urban Institute study.

Some pediatricians describe the pay bump as a children’s health issue. They say children on Medicaid generally have greater health and social needs.

“It’s a matter of valuing children as the future of the state,’’ says Dr. Jaquelin Gotlieb, who practices along with her pediatrician husband, Edward Gotlieb.

“I believe primary care doctors feel a significant responsibility to their patients,” adds Jaquelin Gotlieb, who is 68 and has practiced in Stone Mountain for almost four decades. “That’s why we have hung in there.”

If the pay isn’t restored, she says, “This is going to take some of them and push them over the edge.’’

Dr. Eugene Cindea

Dr. Eugene Cindea

Roughly two-thirds of the Gotliebs’ patients are covered by Medicaid or PeachCare, she says.

Dr. Eugene Cindea, a pediatrician at the Longstreet Clinic in Gainesville, says the extra money “allowed us to expand offerings to patients.”

“It felt good for physicians who were seeing a considerable number of Medicaid patients,” he says.

The goal of the pay hike, Cindea notes, was to increase the number of physicians who accept Medicaid patients.

Without the money, he says, it’s more difficult to devote staff to manage the chronic diseases of children. “It decreases the likelihood that we’ll expand in an underserved area,” he adds.

OB/Gyns were not eligible for the two-year federal pay bump that just ended. Pat Cota, of the Georgia Obstetrical and Gynecological Society, says her organization is asking the state to revive the pay increase and expand it to include OB/Gyns.

The majority of children born in Georgia are covered by Medicaid.




An incentive for doctors

In Alabama, physician participation in Medicaid is a concern. The state says about 22 percent of enrolled primary care physicians now receive 90 percent of all claims payments. The other problem is that Alabama has shortages of health professionals in 62 of its 67 counties.

Niko Corley of the Alabama Medical Association says that “for Medicaid to be as efficient as possible, you’ve got to have physicians managing that care.”

The federal pay hike was supposed to increase doctor participation in Medicaid. But Kaiser Health News has reported that most states say they’ve seen no evidence that it did so — mostly because it was a temporary measure.

“The Medicaid pay boost was never meant to be a silver bullet,” Leonardo Cuello, director of health policy at the National Health Law Program, an advocacy group for low-income Americans, told KHN. Still, he worries about the provider fee cuts. “It won’t sink the ship but . . . I’m concerned it will contribute to access problems.”

Statesboro pediatrician Zeanah notes that many physicians have limited their numbers of Medicaid patients. That’s why her pediatric practice continues to see more patients.

Having the pay hike meant that the practice stopped losing money on delivering vaccines to kids on Medicaid. “We made a tiny profit,’’ Zeanah says.

Not having the pay hike, though, means more hours and less reimbursement. It means Zeanah and her pediatrician partners can’t build an office building to accommodate the growing practice.

Medicaid patients require more work, and are more often late or no-shows due to reasons such as lack of transportation, she says. “We have no social worker available to us. I am the social worker.”

Georgia desperately wants to recruit new physicians, Zeanah notes. “When you don’t have Medicaid payment parity, it makes it hard.”


Narrow networks: Many upset as insurers exclude favorite providers

Dr. Sean Lynch, an Augusta family physician, says dozens of his patients have been notified that he is no longer part of United's Medicare network.

Dr. Sean Lynch (left), an Augusta family physician, says dozens of his patients have been notified that he is no longer part of United’s Medicare network.


Months after she first read it, Vera Brown of Augusta is still upset about a letter she received from her health insurer.

UnitedHealthcare wrote to notify her that it was dropping Dr. Sean Lynch, her physician, from its Medicare Advantage doctor network.

“I’ve been with Dr. Lynch for years,’’ says Brown, 67, a registered nurse. “He treats me like his mother.”

Lynch, an Augusta family physician, says dozens of his patients got similar letters. “For many reasons, it has been a disaster, for us and our patients,” says Lynch.

Brown and Lynch both say they have not received an adequate reason from United as to why the change took place.

UnitedHealthcare’s action in Georgia came after it dropped physicians in several other states from its private Medicare Advantage plans. Overall, thousands of members were affected.

The insurer tells GHN that the Georgia markets affected by the Medicare action are Atlanta, Augusta and Columbus, and that only about 10 percent of doctors in its Medicare network were dropped.

“We do regret any inconvenience to our members,” says Gregg Kunemund, regional vice president for United’s Medicare business in Georgia.

The United move is part of an accelerating trend of health insurers offering consumers more limited choices of medical providers. The resulting health plans have become known generally as “narrow networks.”

Complaints about limited choice of doctors and hospitals in health plans — in Georgia and across the nation — arose during the rollout of the Affordable Care Act exchanges a year ago.

Healthcare CostThe Washington Post recently reported that about 70 percent of health plans sold on the ACA’s marketplaces this past year had narrow or ultra-narrow networks, according to McKinsey and Co. The consulting firm defined “narrow” as excluding at least 30 percent of an area’s largest hospitals.

Narrow networks were increasingly being used before the ACA was enacted, but they’ve become more prevalent under the health reform law, the Post added.

Industry officials say the changes are partly about holding down costs, a prime consideration for consumers who are concerned about affordability (and a major goal of the ACA itself).

“We’re trying to build networks that balance quality and cost,’’ says Graham Thompson, executive director of the Georgia Association of Health Plans, an industry group.

Kim Holland, executive director of state affairs at the Blue Cross Blue Shield Association, told Politico earlier this year that “every indication that we’ve received . . . from think tanks, physicians and consumer advocacy groups, is that the most important factor for individuals purchasing coverage through the exchange is price.”


Traditional trade-off: Choice vs. cost


The interplay between access to providers and costs has existed for years in the health insurance market.

“People have to recognize it’s a trade-off, and I’m not sure they do yet,” Matt Eyles, an insurance expert at the Avalere Health consulting firm, told Politico. “Broader access comes at a cost, and what’s the right balance between access and cost is an age-old question in health care.”

UnitedHealthcare, meanwhile, disputes the characterization of its Medicare Advantage physician network in Georgia as narrow. “We feel we have an adequate network,’’ United’s Kunemund says. “We want to make sure our members get great care.”

Geography, quality and efficiency are among factors that have influenced the company’s decisions, he adds.

The decision has no impact on the retiree members of the State Health Benefit Plan who will be moving to United’s Medicare Advantage plan next year, Kunemund says.

Still, the dislocation for current patients can be jarring, says Lynch, the Augusta physician.

“Most of my patients were assigned to an 82-year-old doctor,’’ says Lynch, who is 44. “No offense to this doctor, but how does it help my patients who have been sent to an 82-year-old doctor who’s about to retire?”


Lack of transparency


It’s difficult to determine how many Georgians have been affected by narrow networks.

But problems with Georgia’s ACA exchange networks became apparent last fall, during the exchange’s first open enrollment period.

Cindy Zeldin

Cindy Zeldin

“Provider directories were inaccurate or not up to date, or people were having problems finding a provider,’’ says Cindy Zeldin of the consumer group Georgians for a Healthy Future, which has supported the ACA.

If limited networks are done right, she says, ‘they’re not necessarily harmful to consumers.” And insurers have a legitimate argument about keeping costs down, Zeldin says.

Health insurers may be looking to drop what they perceive as high-cost doctors or hospitals, or they may be trying to negotiate the paying of lower fees to medical providers, she says.

“It’s not transparent,’’ Zeldin says. “It’s hard to get a handle on how these strategies are designed.”

Patients are often left confused over who’s in and who’s out of a network, says Dr. James Barber, an orthopedic surgeon in Coffee County. “There’s a lack of transparency for consumers.”

“Eventually, narrow networks will get so narrow that patients will revolt, just like they did with the HMOs in the 1990s.”

Barber says he’s concerned that the fear of being excluded from a narrow network may force physicians to accept lower reimbursements.

Plan options will increase for 2015


The state department of insurance has been tracking the issue of how adequate the exchange health plans’ medical provider networks are.

“We’ve been getting complaints from many Georgians,’’ spokesman Glenn Allen told GHN in June. Those consumers have either lost a longtime physician or a trusted hospital by enrolling in an exchange plan, or have not found enough physicians in their network, he said.

Thompson, of the Association of Health Plans, points out that Georgians will have more choices of insurers in the ACA exchange for the upcoming year, both in metro Atlanta and other areas of the state.

Georgia’s largest physician organization, though, says narrow networks “threaten the individual and trust-based relationship that physicians have with their patients.”

Donald J. Palmisano Jr.

Donald J. Palmisano Jr.

“Narrow networks also undermine the economic viability of the medical profession, which employs a lot of Georgians and which makes a significant contribution to the state’s economy,’’ says Donald J. Palmisano Jr., executive director of the Medical Association of Georgia. He adds that the increase of these networks “will exacerbate the shortage of physicians in Georgia.”

“MAG believes that patients should have the freedom to see the physician of their choice as long as the physician is willing to participate in the patient’s health insurance network,’’ Palmisano adds.

John Crew of Strategic Healthcare Partners, which consults for more than 30 hospitals, 600 physicians, and 26 behavioral health centers in Georgia, says he fears that all insurance companies are using this tactic to drive down reimbursement to medical providers.

He says narrow networks may favor those physicians who are employed by hospital systems. They also could exclude rural physicians, Crew says.

Zeldin, meanwhile, says that consumers should shop around as they review health plans, and ask for up-to-date provider directories from insurers.

Meanwhile, in Augusta, Vera Brown is changing her Medicare coverage so that she can keep Dr. Lynch as her physician.

“I’m going to stay with Dr. Lynch, whatever plan I go on,’’ Brown says. “When you get older, you don’t want to do all this flip-flopping. It’s not good for older folks.”

The PA pipeline: More trained to fill Georgia’s growing need

Members of the PA program at Georgia Regents University wear blue to raise awareness of diabetes

Members of the PA program at Georgia Regents University, including Timber Wages, wear blue to raise awareness of diabetes

Her 27 months at physician assistant school was an intense experience, says Timber Wages.

“It’s like trying to drink water from a fire hydrant,’’ says Wages, 31, who attended the PA program at Georgia Regents University in Augusta.

A fire hydrant?

“The volume of information is overwhelming,’’ she explains, adding with a chuckle, “but not impossible.’’

Timber Wages

Timber Wages

Wages, originally from Calhoun in northwest Georgia, weighed several job opportunities when she graduated about a year ago. She joined an Augusta urgent care center as a PA in primary care, and also works at a Columbia County detention center.

Over the past decade, both Georgia and the nation have seen a surge of PAs. The higher demand comes from several factors: the growth in outpatient clinics; the shortage of primary care physicians; and the added emphasis on cost-effective, team-based medical care.

A physician assistant is a health care professional who has the training to perform many of the duties that doctors routinely handle. PAs must be licensed and each must work under the direction of a physician.

About 95,000 PAs are practicing across the country, up from 43, 500 in 2003.

The number of PAs in Georgia has increased by 67 percent over the past 10 years, now surpassing 3,000. Still, experts say there’s a shortage of them in the state.

Though she and other PAs are not allowed to prescribe certain medications, Wages says she can do most things a primary care physician can do. That’s why PAs are so valuable in primary care: They can relieve much of the workload of doctors.

A large majority of Georgia PAs, more than 75 percent, are currently practicing in metropolitan areas, according to a state workforce survey.

Wages says an attractive feature of being a PA is lateral career mobility, where she can work in primary care for a while, then transfer into a specialty, such as dermatology or orthopedics.

nccpaMost physician assistants end up going into a specialty, says James Cannon, board chairman for the National Commission on Certification of Physician Assistants.

All are trained in primary care, which can help a PA who moves into specialty medicine, says Cannon. He’s a PA who works in psychiatry, and while he treats substance abuse patients, he also can address their primary care needs.

The NCCPA organization, based in Johns Creek in the northern Atlanta suburbs, is the only certification and licensing exam entity for the PA profession. NCCPA certification (passing a PANCE exam) is required for initial licensure in every state.


A calling that’s relatively new


The PA profession arose in the 1960s, when physicians and educators recognized there was a shortage of primary care physicians.

To help address the need, Dr. Eugene A. Stead Jr. of the Duke Medical Center, formed the first class of physician assistants in 1965. He selected four Navy corpsmen – military medics who treat sailors and Marines – to be the first students.

Now, PAs and nurse practitioners (who also can handle many of the duties frequently left up to doctors), are considered part of the solution to primary care shortages, especially with the coverage expansions from the Affordable Care Act.

Chris Parker, associate project director at the Georgia Health Policy Center, adds that under the ACA, “as more individuals find coverage, an even greater demand will be placed on our primary care system, especially in rural and underserved communities.

A Rand Corp. study published in November said new roles for PAs and nurse practitioners may cut a predicted shortage of physicians by about 50 percent.

“Growing use of new models of care that depend more on non-physicians as primary care providers could do much to reduce the nation’s looming physician shortage,” said David Auerbach, the study’s lead author. “But achieving this goal may require changes in policy, such as laws to expand the scope of practice for nurse practitioners and physician assistants, and changes in acceptance, on the part of providers and patients, of new models of care.”

Using PAs and nurse practitioners in “medical homes” – teams of health professionals working together to coordinate care – can relieve the doctor shortage by serving larger numbers of patients than a single physician can treat, experts say.

Georgia now has four PA schools – at Emory in Atlanta, Mercer in Atlanta, Georgia Regents University in Augusta and South University in Savannah.

USA Today reported last year that according to the American Academy of Physician Assistants, 60 new physician assistant programs were waiting then for accreditation, and 10,000 new PAs were expected by 2020.

Jeff Chambers is one of five PAs on an  Air National Guard special medical team.

Jeff Chambers is one of five PAs on an Air National Guard special medical team.

“There are a lot of jobs available, especially in emergency medicine,’’ says Jeff Chambers, a physician assistant who works in orthopedics in Athens. “More primary care jobs are opening in rural areas.’’

As a PA in orthopedics, he says, “I can put bones and joints back in place,’’ plus assist in surgery.

It’s cheaper and quicker to train a PA than a doctor, says Chambers, a past president of the PA association.

Nationally, the median salary for a PA is about $97,000.

Wages says she wanted to practice in Georgia because it’s her home state.

“I’m very proud to be a PA,’’ she says. “And I enjoy general practice much more than I anticipated.”


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