Shadow Me Next!

15 - A Veteran Physician Assistant's Views on Medicine: Past, Present, and Future | Erich Fogg, PA-C

• Ashley Love • Season 1 • Episode 15

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Imagine navigating nearly three decades in healthcare with the resilience and adaptability of a true innovator. That's exactly what our guest, Eric Fogg, has accomplished as a physician assistant (PA) and leader in healthcare operations. In this episode of Shadow Me Next, Eric reveals his extraordinary journey from a budding interest in sports medicine to pioneering new telehealth initiatives and leading pandemic response efforts. Eric's passion for mentoring future healthcare professionals shines through as he shares how PAs can significantly shape healthcare policy and operations.

Join us as we explore Eric's transition from clinical practice to taking on powerful roles in administrative leadership. Discover the unique dynamic of a PA-led urgent care setting where Eric excelled in managing budgets, building a network of urgent care centers, and navigating the perceptions of non-physician leadership. His story is a testament to hard work and the willingness to take risks, proving that PAs can thrive in roles traditionally reserved for physicians. Eric's commitment to providing quality care underscores the importance of seizing opportunities and building a reputable career.

Our conversation also touches on the exciting potential of technology in the healthcare landscape. From AI and wearable technologies transforming chronic disease management to the nuances of PA recertification and the recent title change from "Physician Assistant" to "Physician Associate," Eric offers insights into the innovation shaping the future of the PA profession. We highlight the role of empathy and genuine care in medicine, emphasizing the human touch that remains irreplaceable despite technological advances. Whether you're a pre-health student or simply curious about healthcare, this episode promises to enlighten and inspire.

Find Erich at Pathway To Pass! 

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Ashley Love:

Hello and welcome to Shadow Me Next, a podcast where I take you into and behind the scenes of the medical world to provide you with a deeper understanding of the human side of medicine. I'm Ashley, a physician assistant, medical editor, clinical preceptor and the creator of Shadow Me Next. It is my pleasure to introduce you to incredible members of the healthcare field and uncover their unique stories, the joys and challenges they face and what drives them in their careers. It's access you want and stories you need, whether you're a pre-health student or simply curious about the healthcare field. I invite you to join me as we take a conversational and personal look into the lives and minds of leaders in medicine. I don't want you to miss a single one of these conversations, so make sure that you subscribe to this podcast, which will automatically notify you when new episodes are dropped, and follow us on Instagram and Facebook at Shadow Me Next, where we will review highlights from this conversation and where I'll give you sneak previews of our upcoming guests. And where I'll give you sneak previews of our upcoming guests. Today, I'm excited to introduce you to Eric Fogg, a leader in healthcare operations, innovation and education. Eric has dedicated nearly 30 years to transforming clinical services, ensuring that patients receive high quality, accessible care. As the director of clinical operations at his hospital of employment, he has expanded their walk-in services from one clinic to four, all while maintaining an impressive rating in patient satisfaction.

Ashley Love:

But Eric's impact doesn't stop at clinical leadership. He was instrumental in launching Maine's first hospital-based virtual walk-in service, pioneering the use of telehealth to expand access to acute care. He also played a vital role in pandemic response efforts, overseeing COVID-19 testing and treatment programs. Beyond his administrative work, eric is a passionate educator. Through Pathway to Pass, he has mentored over 177 students through their board exams, helping them take the next step in their medical careers. In today's conversation, eric shares how a chance interaction with a PA led him towards the PA profession at a time when the field was still growing. He discusses his unexpected path from clinical practice to hospital leadership and how he answers the question can a PA do that? Time and time again, proving that PAs can lead service lines, sit on hospital boards and shape healthcare policy. He also reflects on the evolution of the profession over the last three decades from the challenges of providing profession over the last three decades, from the challenges of providing PA capabilities in hospital systems to the expansion of roles in emergency medicine, urgent care and telehealth. One of the most powerful moments in our discussion is when Eric describes how he built trust and credibility in leadership by letting his work speak for itself, focusing not on titles but on delivering high quality patient care and operational excellence. Eric's journey is one of resilience, adaptability and a deep passion for improving healthcare.

Ashley Love:

Please keep in mind that the content of this podcast is intended for informational and entertainment purposes only and should not be considered as professional medical advice. The views and opinions expressed in this podcast are those of the host and guests and do not necessarily reflect the official policy or position of any other agency, organization, employer or company. This is Shadow Me Next with Eric Fogg. Hey, eric, thank you so much for joining us on Shadow Me Next. You have this fantastic 29-year career as a PA and it's so varied and colorful and full of things that people might not realize a PA can do. Thank you for joining us today.

Erich Fogg:

Sure sure my pleasure. Happy to be here. Thanks for the invite.

Ashley Love:

Awesome, Awesome. So let's start. You've been working as a PA for 29 years almost 30 years and I just want to thank you for your service to the field, for your service to patients and to the PA profession. I'm sure it has been a really interesting road over 29 years.

Erich Fogg:

It sure has, and I had no idea where this profession was going. Back in the early 1990s, when I was exploring what I wanted to do with my life and certainly learning about the PA profession, I was intrigued right, I was excited, as a matter of fact, that the undergrad college that I went to was getting ready to start their own PA program. So in front of my eyes was this developing new PA program. So I was further intrigued by the process. But fast forward, almost 30 years later, I would not have guessed the journey and the voyage that this profession has taken me on. It's been a blast.

Ashley Love:

It's amazing Now, 30 years ago, what initially inspired you to become a PA. There were far fewer physician assistants than there are right now, so how did you become acquainted with the profession?

Erich Fogg:

Yeah, great question. So when I was in high school I was an athlete and I found myself banged up a little bit and spent a lot of time with our athletic trainer and then subsequently physical therapist. That kept me on the basketball court and I was really intrigued by sports medicine. As a matter of fact, my initial thought was I wanted to be that physical therapist that got people back on the field, on the court. And again in the late 80s, early 90s, the PT profession was the explosive profession, incredibly competitive to get into limited spots and programs.

Erich Fogg:

I was a good student in high school, national Artist Society, and I was trying to be competitive to get into graduate PA school. So I thought I would take an undergraduate major as pre-med, like bio right, like most of us do, and I went to a small private college in Western Massachusetts called Springfield College in Springfield Massachusetts, which is known very famous because it's the birthplace of the game of basketball, which was invented on its campus in 1891. Yeah, yeah, very cool. And what was cool about our major was that every quarter or so they bring in an allied health professional to come talk to our cohort and our group. So a physician came in, a physical therapist came in One quarter a PA came in who worked at the local trauma center at the emergency department in Springfield, massachusetts, and I was just mesmerized by what he told me. He did his role, his responsibilities and that was probably the turning point for me to really start looking at this. In the meantime I heard about our college starting a PA program, so we had a front row seat to watch the development of that and I was in after that.

Erich Fogg:

And fun little fact, when I applied to PA school in 1993, there was only about 50, 55 programs in the country at the time 55. Now there's 320 plus programs, so really explosive. But that was really it just thinking something along. Healthcare, physical therapy being just by happenstance introduced to the profession. That was starting to gain a little traction. But it's not on the US News and World Report right as number one and number two job in 1993. We were far from that, but that was it. That was the beginning.

Ashley Love:

What a fantastic experience to be able to listen to all of those allied healthcare professionals speak and talk about their life. That's exactly what we're doing with this podcast is just getting all of these voices together and presenting a day in the life and the challenges and the successes and why we love doing what we do despite those challenges. So what a great thing. I think that that element of shadowing and just being able to pick the brain of somebody who does it every day it's so helpful and it can just direct the entire course of your life. Like you said, you're just mesmerized by what that PA was talking about. Was he also in emergency medicine, acute care?

Erich Fogg:

Yeah, for sure, for sure.

Erich Fogg:

Yeah he worked at the trauma center. He talked about working, traumas working. I was like wow, and, to my 20-year-old brain, like I just thought that was just what a physician did, right, and that other healthcare professionals were part of that healthcare team in that process, that was just mind blowing to me. Right, there was no. You know, back then I can't believe I'm saying that expression. That just makes me feel back then, right, there was no internet, there was no, like it wasn't, like I could go home and Google it, right, or anything like that.

Erich Fogg:

It wasn't like I could just put a YouTube video on and review what this person was. You had to. Really you had to go to the library, right, or figure something out to. Really you had to go to the library, right or figure something out, so that was your way of getting more information about. This was different back then.

Ashley Love:

I'll just say and this is just such a perfect segue into the fact that you have been doing this for almost three decades now. I'm sure you have noticed major changes, and not just healthcare, but also SPAs as well, and probably too numerous really to break down. But aside from the invention of the internet, what is something that you've just seen PAs do, or seen PAs really develop? That is just mind boggling to you. 30 years ago, when you first jumped on this boat, you never would have thought that PAs would be involved in this sort of thing, or perhaps even you would be involved in this sort of thing.

Erich Fogg:

Yeah, I think we all go into this to be healthcare providers, right that's. We want to take care of patients, right? That's the most common reason we go into this and certainly that's why I did. But from where it's come? I remember me and a classmate. Both were hired at a small critical access hospital in rural Georgia. We were just talking about that before we got started.

Erich Fogg:

And we showed up on our first day and all of a sudden the med staff realized that there was no bylaws or no guiding principles for how we actually could function and work in the hospital. We had a contract, we had started and then someone said wait a second, what are these guys? Are they part of the medical staff? What can they do? What is the whole? It was crazy so for a week, until they figured it out and had an emergency meeting with the medical executive committee and figure this out, how we could get there. It was just a bumpy start, to say the least. I thought at one point is this even going to work out.

Erich Fogg:

Yeah, to get to the point where I am in my career now, where I sit on the board of trustees of the hospital right, I am a non-physician director of 11 service lines right, and really manage a team of providers, that was an opportunity that I would never have envisioned doing 30 years ago.

Erich Fogg:

And, yeah, so it's come full circle. I think, to your point, what PAs can do in the education, the experience, the knowledge that we can bring to a health care system and be leaders, be directors, be innovators right, be nimble, right and create all sorts of improvements to our health care system from access to use of technology to just our flexibility as providers I think has been remarkable and as more and more people recognize the value. When I came to the hospital I'm at now, 18 years ago, I was one of five non-physician providers. Right, there was three PAs and two nurse practitioners. Now there's 80. And to grow that process, we just stood up an APP council that I co-chair. So now we have a seat at the medical exec, we're full voting members of the med staff. So all of those things have been an evolution, so to speak, of our profession and where we've taken it.

Ashley Love:

That's great and I'm so glad you mentioned leadership and education and all of these things, all of these roles, because you have held a lot of these, most of these roles, and we're going to jump into all of it and I just can't wait. But tell me, are you still practicing clinically, even as leadership and even as an educator? Are you still in clinical practice, kind of what originally brought you to being a PA?

Erich Fogg:

Yeah, so it's as of probably a year and a half ago I had regular shifts. As my role in demand expanded and our CEO asked me to take on more projects, my clinical responsibilities have dwindled. Now, every single day I am I run at least acute care wise, I run for urgent cares and our wound center hyperbaric medicine program. So every day I'm doing medical direction on the phone and I am really navigating patient care, but not the same as old-fashioned in the trenches clinical shifts anymore. And I'll tell you what. I incredibly miss it and I definitely see myself finding some time to migrate back to that.

Erich Fogg:

There's nothing that replaces putting out fires every day and all day can be challenging in itself, but I miss an old-fashioned shift where there's nothing more, I think, rewarding than direct patient care. So, drifted a little bit away, but I have my hands in it. Every day I manage direction of patient care. I talk through cases with some of my providers. All of our urgent cares are staffed by PAs and MPs, so we don't have any physicians on site. So I'm usually the first call that does triaging, medical direction, providing guidance, advice and those types of things.

Ashley Love:

Yeah, You're definitely managing patients. It's just you are an extension of the person who's actually face-to-face with these patients and because you've done it for so many years, I'm sure it's very second nature and it probably feels very gratifying to help that APP walk through some of these things that you've definitely seen in clinical practice.

Erich Fogg:

Yeah, we hire some new grads from time to time, even mentoring them and getting them started. You remember starting your first job right, Wanting to have both a little bit of opportunity to grow your skill sets and develop, but having somebody on a short kind of phone connection that's hey, can I run something by you type of thing is or be just stopping in when I know that providers and hanging out with them for an hour or so and reviewing some of their charts or going over that type of thing. So I do a lot of mentoring, I do a lot of support, onboarding as well as people start their career.

Ashley Love:

Absolutely. Oh, that's so cool and I'm so glad you mentioned this. I spoke with a PA who's currently working in urgent care a couple of weeks ago. His name's Jim and he has a physician who signs his notes, but really the physician exists to him on paper and that's really it. When he has concerns, medical concerns, when he just wants to consult somebody, get a second brain involved, he calls the PA the PA who owns the practice and it sounds like it's happening. But your urgent cares it's all staffed by NPs and PAs and I think that is just such a cool thing we often so much think of as PAs. We think of the next person up, so to speak, is going to be a physician and that's who we're going to consult with and that's who we're going to pick their brain on certain things and certain patient problems. But in your case it's a PA, which is fantastic, and a PA with obviously loads of experience. Are you talking to them a lot? Is it pretty consistent?

Erich Fogg:

Would you say yeah, I would say every day. So on any given day there's eight or nine PAs of mine working and I'm on that shift. We double coverage, our places, and so every day I'm getting some sort of contact. For sure, and given what's going on the last few weeks with Luwe and all the respiratory stuff, there's a lot of volume and a lot of managing of patients, both acutely and remotely. So yeah, it's something that we touch every day.

Ashley Love:

Very cool, very cool. Let's shift to your career in leadership and actually let's talk about that shift. So what did that transition look like from clinical medicine into administrative leadership? Was it hot and cold all of a sudden you were in it, or was it more of a slow burn? It was a little bit more gradual.

Erich Fogg:

Yeah, I would say from a clinical leadership standpoint it was a little bit of a slower burn, I think. One thing that was, as I look back on it, I think what really led to my recognition of leadership is providing great patient care. So when I came to, for example, this organization almost 20 years ago, I was helping to stand up our hyperbaric medicine and wound care service line and it was a relatively new field to me. There's not a lot of PAs that do wound care or hyperbaric medicine and I was brought into it by an emergency medicine mentor of mine because of the HBO piece, I think, and some of its application in emergency medicine, like carbon monoxide poisoning or the bends or those type of things, I think is the connection, the attraction. But I quickly was put in a position where not only did I have to learn the new discipline but I was also responsible for being the program director and setting up this business, so to speak. And when you get into administrative roles in healthcare you learn another skill set that you're not taught in PA school and that's how to run a business right. I was responsible for the budget and the only budget I ever ran was me and my wife running the household budget right. We have a checkbook right. Bills come in, you pay them right. You write checks, you keep a ledger, right. That was the extent of it Excel spreadsheets, oh my goodness. So that was an immersion into that.

Erich Fogg:

But what it was I think Ashley was just taking on that opportunity, right, and having this desire and passion to run a high quality right, high patient satisfaction, reputable service line and the other added pressure to this and I think your audience will appreciate that was oh, we have a non-physician leading a service line. That added another layer. Can that happen? Is that possible? Because that was a relatively new concept at our small healthcare system. It was more traditional in its history. Right, there was always a medical director that was a physician, right, and so that part maybe that was pressure I just put on myself, I don't know, but I just felt it that I had to extra prove myself. So everything was attention to detail, hard work, commitment, attending meetings, putting myself out to the medical community, meeting and greeting right, networking, all that type of stuff, but most importantly, when that patient that we cared for went back to their primary care provider and they had this tremendous experience and their wound was healed or their condition improved. That helped drive that reputation of quality and, hey, maybe this guy knows what he's doing.

Erich Fogg:

Then, after getting recognized in that one small service line, there was this idea of starting this network of urgent cares. Right, those were starting to get popular in the 2000s, early 20 teens, and so Eric, with his emergency medicine background, became that person. I had just put myself in a position to be recognized to do that and take that on, because I had proven myself in this smaller kind of hey, let's say, eric tried this and we started with one, and then two, then three, then four, and it just built from there and I just opportunity begets opportunity. That's the message that I would give you and your listeners is don't be afraid to put yourself out there, Take a chance, but just do a great job.

Erich Fogg:

Right, it sounds so simple and it's not simple, but do a really good job, just like anything else in life. Right, if you do a really good job, people tend to notice. So that was it, and then it grew from there. Then I was asked to be the first PA ever on our hospital board of trustees as well, or to take on some other committee work that was important to the organization, like this new APP council. It seems like there's momentum that builds once you start adding successes to your docket.

Ashley Love:

You mentioned a couple of times. Now you've said the question has been presented to you Can a PA do that? Can a PA do this? Can a non-physician person be this person in this role? And you have answered that question. Yes, it sounds like so many times. And then you also have to back that up right. You have to prove it, you have to do a good job and when that happens, it does sound like you're rewarded. Did you ever feel like you faced a lot of controversy or a lot of pushback? And if you did, how did you put your head down and just kind of power through and continuously show up every single time?

Erich Fogg:

Yeah, I think most well a lot of your listeners might relate to if you work in a community or a culture. There's and it's much better now than it was, I think, 20 years ago that there might be some people who are less supportive to this role, right, and maybe don't have a seat at the table. That's their history or their background or their reputation, reputation. So it was always a little challenging when I needed to make a call to a physician who may or may not have appreciated that I was not Eric Fogg the person, but that a PA was caring for their patient in a specialty practice, so to speak. And I think early in my career I might have got a little bump on that type of thing, but I didn't let that deter me because I let the work speak for itself, right. Challenge me If you think you know, if you have feedback for me or if you think we could have done something different or something better. I welcome that feedback and I just I put myself out there in the work that I did to speak for itself, right, and I tried to get away from titles or letters or credentials after my name and just let the quality of the work that we did speak for itself and it got to the point I'll never forget.

Erich Fogg:

The last frontier at our hospital was putting PAs in our emergency department. It had been a traditional physician-based department and one of the nicest compliments I got was I'm not sure we're ready yet for this integration, but we'll let Eric break the ground on this right. So that kind of was that recognition that I had reached a point in this organization, that there was trust. I had built trust and then once I started doing some shifts in demonstrating what the role of a PA could be in that department that was eight, nine years ago. Whatever that department has PA coverage seven days a week now and it's just integrated as part of the process. Yeah, it's just. I took it always as a challenge, never as a dis or a disrespect, cause if you get caught up in that mindset then you're always in this defensive posture all the time. I looked at more as an opportunity. Let me prove to you. Let me prove it to you.

Ashley Love:

I think that's great. You're right, it's all about a mindset, absolutely, and you do it so confidently and I think it probably comes from a lot of practice. Do you ever feel nervous about whenever you're asked to start these new initiatives or develop these programs, anything? Are the nerves still there or do you just rely on the fact that you've done this time and time again and with practice and with seeing a history of success, it just becomes a little bit more comfortable?

Erich Fogg:

Maybe experience allows a little bit of mitigating some of those nerves, but I'd be lying to you if I didn't get anxious anytime there was a new opportunity. I'll give you an example. I've done medical malpractice work for almost 20 years, right? I've been deposed 36 times, I've been to trial nine times, I reviewed over 50 cases and I had a trialosed 36 times. I've been to trial nine times. I reviewed over 50 cases and I had a trial testimony last week. And no matter doing it for 20 years as I got ready to go under oath, eric, will you raise your right hand? You swear to talk truth, right? I just, you know, got that. I don't care how many times you've done it If you're not human, if you don't get a little bit anxious about those.

Erich Fogg:

But anxiety is often I look at it as a motivator right, anxiety or being anxious allows you to be more focused, to be more driven. You can. Anxiety can be paralyzing. I work with maybe we'll talk about this I work with students who are remediating their board exams or struggling with their high stake exams during PA school and one of the things that challenges students often is that performance anxiety or test-taking anxiety. I've developed techniques and strategies to help me navigate when I get anxious, whether that's breath work, visualization, positive self-talk or just thinking back to the successes I've had as things that comfort me a little bit as I approach the project. This isn't my first rodeo, right, I've been successful before I can do this. I got this type of thing. But, yes, I get a little nervous, right, I get a little nervous.

Ashley Love:

It's nice to hear. It's nice to hear that, even though you are so practiced and so successful, the nerves are still there, but they do. They sharpen us An. Even though you are so practiced and so successful, the nerves are still there, but they do. They sharpen us Anxiety. I do think it can sharpen us as long as we use it as a tool and not let it overwhelm us. Let's talk about Pathway to Pass, because you've already mentioned it and I think it's just such a cool thing that you offer. You have helped over 130, I believe it is students succeed on their board exams, which is huge.

Erich Fogg:

Thank you for that and what you're doing with these students, what interested?

Ashley Love:

you in this in the first place. So my update is 177.

Erich Fogg:

I've been on a roll here in the last couple of months, but I'll tell you the story really quick and remember I had an educational background. Back in the early 2000s, me and some friends started a CME company. We traveled all over the country and taught so education, I was involved in PA education. I was a former program director, all that. So I have this educational background. But I also had some experience. I was trained by the National Board of Medical Examiner to write high-stake exams and for years I wrote high. Back in the day there weren't QBanks like there exists now that students can use to prepare for exams, exists now that students can use to prepare for exams. Faculty wrote their own questions. I did some work with the NCCPA and got involved with that organization. So I had this background regarding psychometrics of exams and test taking and being an educator and all this. But here's the story and you're going to love this story.

Erich Fogg:

About five years ago I was working a clinical urgent care shift and the rad tech came into my little dictation room and said Eric, a woman called here looking for you. Here's her phone number. You were seeing a patient and she hands me this piece of paper and it has the name on it that I recognized as a colleague from maybe 20 years ago. Right, I thought to myself, is this a patient or no? It didn't sound like a patient, eric. But she said to give her a call back and this colleague was the former program director at Yale and she was very involved in PA education and helped start the program in Boston, and so I knew the name and it had a Connecticut area code on it. So I thought to myself this has to be, this has to be Mary, my old colleague who went to Emory a couple of years before me. I'd just known her most of my career, so I called her up and I said first of all, mary, good my career. So I called her up and I said first of all, mary, good to hear your voice, how's the family? It's been years Like, how are you Good, how are you, how's your family? She says I'm sorry to bother you, but I thought of you recently because I have a family friend whose daughter just failed the pants. And I said oh, mary, I'm so sorry to hear that, but why are you calling me Like? She said Eric, I was racking my brain, like how can I help my family friend and she says you know my background, but I don't have the expertise you do Like you're like. I thought of Eric Fogg and I have to. She said I Googled you. I haven't talked to you in years. I found out on Google where you worked no-transcript. She was embarrassed, she was upset, disappointed, she was heartbroken, right, but she was hungry to fix it. She was hungry to fix it.

Erich Fogg:

So my next question was, because I know the background of this exam pretty well, I said what was your score? And she said, eric, I got a 239. So for all the listeners out there, or I don't know if you remember your pants 350 is the cut score. So 239, not good, not good Off. Lots of work, big mountain to climb. So I thought to myself I lost all the color in my face. Now I'm being set up. I have Mary who has this high expectation of me, and I have 111 points to make up.

Erich Fogg:

So what I did? Really quickly I'm making this story all too long, but this was during COVID, so we were meeting just like this on Zoom. So I threw up like a question on it, shared it on my screen and I said Maria, walk me through this question. And I could immediately tell she was smart and bright, which anyone who gets into PA school. Like smart, high admissions criteria, very difficult curriculum to get through, it's hard, right. So if you graduated from PA school, you have a foundation of knowledge that I would assume is solid, right. But I could tell she was smart, she was bright immediately.

Erich Fogg:

But as we started doing questions, I recognized that she had these inconsistent test-taking errors overthinking questions, changing answers, narrowing it down to two, picking the wrong one, missing clues, not understanding what the clues were. Just didn't have a good process and she would what I say, leave points on the table by getting questions wrong where, if I talked to her about the content, she knew the content. So this light bulb goes off. Like all these years of writing test questions and all this experience and training, I'm looking at the world through the lens of a test writer and I realized she's looking at the world through the lens of a test taker. And if I just show her my lens, like, why do you think the author picked a 17-year-old female? Why is that important, eric? I've never thought about that way. What do you mean? You've not thought about it. That's the the whole point of the question. It's like this light bulb goes off, and so to make a really long, this is even getting longer.

Erich Fogg:

I work with her once a week for eight weeks, so eight hours. She needs 111 points. Now, as the test approaches, I am not optimistic that I can make that jump just in one attempt. I think maybe I have to stage this, maybe a jump and then a jump again, maybe three times. I knew she was going to do better, but I had no expectation and I'd never done this before she takes the test calls me a week later in tears. She got a 390. Goes from a 39 to a 390. Wow, a, did I get lucky? Or B? Was I onto something? I just went back to work. I have a busy job, right, so the program that she attends calls me a week later.

Erich Fogg:

Eric Fogg, we've been director here of the program for 12 years. We've never had a student improve 160 points. Who are you? Who are you? Hey, by the way, we have another student that didn't pass. Can you help them? So that was it, that was it, and, as of this morning, 177. And now I work with many programs with second year students who are identified as at risk, who are struggling with EORs and that type of thing, and it's just turned into something that I never.

Erich Fogg:

It was a phone call when I was working a clinical shift from an old colleague who had a friend whose daughter failed the pants. And here I am, this. It's amazing. My day actually started yesterday from. I got a text message at 7.17 in the morning from a student who I helped last year who had failed it four times before she had got to me. She had graduated in 2022, had reached out to me in 2024 after four failures. I worked with her for three months. She passed the exam this past fall, got her dream job, and I hadn't heard from her in a few months and I wake up to a text that says Eric, I just want you to know. I'm sipping my coffee getting ready to head out to my first day of the PAC and I want to say thank you.

Ashley Love:

Wow, I have chill bumps. That's amazing. How good does that feel? That has just got to be incredible, and I just need to say it because I feel like even somebody who does not pass their test four times is going to be an incredible PA. It's a standardized test. It's like you said there's technique and strategy and you know the material, but you have to know how to apply the material. And good for her. I hope she has enjoyed her first day.

Erich Fogg:

Yes, and this afternoon a student who I helped pass said Eric, I just got my dream job, a PA oncologist at St Jude Hospital in Memphis Amazing, and I wouldn't be here without you like this. And I don't know if that's necessarily true, but these are bright, talented people that maybe just needed a little bit of direction or whatnot, but it has become a passion project and talk about all the things that you want to even talk about tonight. This is by far one of the most fun and rewarding things. These people are vulnerable with me. These people come to me when they're down and out, and to just hear their story, to give them hope, to give them inspiration, to give them confidence, has been just incredible. Patient care is great, helping people get better and all that. That's rewarding, but this is its own thing and it's been great.

Ashley Love:

I'm so glad that you're doing this and it does. It sounds like it's a really rewarding thing because these students have proved that they've proven themselves for the two, two plus years that they've been in PA school. Obviously they've passed PA school.

Erich Fogg:

They're trying to take their boards and they just can't pass that god awful test. And you've taken it at least a handful of times. At this point I'm up. This year I went for my Pan Ray this year, so we'll try it again.

Ashley Love:

Are you doing the Pan Ray or the Pan Ray LA?

Erich Fogg:

See, I'm a one day guy, let's go. I'm not like cause I'm a really good test taker and I'm an expert test rep To me. Let's go, do it, you're probably excited about it. I put a few hours in, right, I'm ready to go. I love that, but I like that the NCCPAs create different pathways for people. Meet them where they are right In terms of whatnot. Yeah, that's a great tool for those who self-pace busy that type of thing. I just don't love standardized tests. There's a lot of people that just Absolutely, absolutely.

Ashley Love:

When we recertify as PAs, we recertify every Now it's every 10 years and there's two options. Like you were talking about, you can go in, sit at a testing center with you and the computer in your brain, take the test and that's it. It's a one-day, one-time thing. Or the other option, like I just finished and passed, is the Panray LA longitudinal assessment and that is where you have X number of questions, a quarter over an extensive amount of time so I think it was two years for me. It can be up to three years and you get to do that at home at your computer and there are benefits to both. And it's so funny because people are very black or white on this issue. Either they're like you and you'll say no, absolutely not One time I'm done, I'm just going to take it and pass and be confident. Or they're like me, where I'm like I cannot fathom a life where I would actually go and sit down and take that test again in a testing center.

Ashley Love:

So it has been a really interesting addition, I think, to the PA profession and a nice way to, like you said, meet people where they are and where they're most comfortable. So that's been really fun. Now, before we step away from your career in education, which is just so much more in-depth than we already talked about, we have a segment on the show called Quality Questions. It's something that is our gift to you and to help you really just discover some interview questions and things that you might not have heard or you might not have considered. So, eric, do you have a quality question for us? Before we hear what Eric's quality question is, keep in mind that there's more interview prep, such as mock interviews and personal statement review, over on shadowmenexcom. There you'll find amazing resources to help you as you prepare to answer your own quality questions.

Erich Fogg:

Yeah, and listen. I think one of the really hot topics in our profession over the last probably going back decades has always been the name physician assistant, right? Is it the right name, right? What does the word assistant mean and what's the connotation of that thing? Does it make patients more confused? Does it best represent the role and responsibility that we do? I think most people would agree it probably wasn't the best name, but over time, this has been a topic that had been approached. So one of my quality questions would be what are your thoughts on the change in the name from physician assistant to physician associate? This was something that was voted on through our legislative body in the AAPA back in I think 2020-ish. I think 21, 20, can't remember the exact, but it's within the last five years and that has been a long time coming. This has come up multiple times over the years, and so I think the quality question is do you think the name change from physician assistant to physician associate will be a benefit, right?

Ashley Love:

To the profession. So that's such a great question and we're not going to give you the answer to that, because that's just got to come from your heart and your brain. But people I think people have very differing opinions on this too. Like you said, it is truly a hot topic and it it's happened. Physician associates is happening. How do you introduce yourself, eric, when you're speaking with a patient or in hospital management? How do you? What do you say?

Erich Fogg:

So I live in Maine and this was something that I learned. So I'm from New England, from Massachusetts, originally, but spent time in the South and went to Emory and my first job was in rural Georgia and very. Something about the South I always love was some of the formality of South. As a matter of fact, what I loved was when little kids even addressed you as an adult it was always Mr Eric right, it was Mr, but your first name. I always thought that was super, super cool and stuff. But I was. It just seemed like the culture was you addressed.

Erich Fogg:

Even my supervising physician, who I thought was my friend, I always, out of courtesy would say, or out of respect, say oh, dr Jones or Dr, whatever right. So in living in Maine or Northern New England there's a little bit less formality to it. So I actually, when I go into a room to see a patient I said, hey, I'm Eric, the PA working today. I'm here to take care of you. How can I help you? So I would say my first name and I always refer to myself as a PA. I have a badge that says physician assistant on it, very visible to everyone, my picture on it, that type of thing.

Ashley Love:

So I'm properly identified that sort of thing, but I was going to introduce myself by my first name and the credential PA. Yeah, no, that's exactly what I teach you. And there was one PA that I rotated with. He was in urgent care in Palatka, florida and he would say hello, I'm so-and-so physician assistant. And he's the only person that I know that literally every patient spoke it in full for that patient. And now, granted, this was in Palatka Florida, which is very rural, and perhaps not many of them knew what a PA was. So it makes a lot of sense, but but no, the formality is. It is very interesting. That's exactly how I introduced myself to you. I'm Ashley, I'm one of the PAs here and I'm proud of that, you know, and I think that nowadays people do recognize PA, whether they recognize physician assistant or physician associate. It will be, time will tell, we'll find out, for sure, for sure, very good.

Ashley Love:

Thank you for that quality question. That was great, eric. Let's can we talk a little bit about innovation, because innovation is such a big word and I think there's a lot of excitement around innovation and you have such a fantastic history with what innovation looks like. As a PA, you have launched Maine's first hospital-based virtual walk-in service. You developed a COVID-19 testing and therapeutic program virtual walk-in service. You developed a COVID-19 testing and therapeutic program.

Erich Fogg:

What does innovation mean to you as a PA and why is it so important? Why are we even talking about it? The world is changing quickly, right, very quickly, and our ability to navigate complex systems can often be better, be made easier, by innovation, and we'll use the virtual, like telehealth has become, and certainly COVID really rapidly accelerated the adoption of telehealth, but it's been around for a long time, a really long time, probably longer than people think. And if you're from the West Coast listening to this, the whole notion of telehealth visits really started in the 2000s, probably on the West Coast. But I saw an opportunity at our community hospital that we could offer convenience and access by.

Erich Fogg:

I noticed, working in our urgent cares, that we saw a lot of relatively low acuity, simple type things from poison ivy to really benign presentations that, although required management and care, didn't really require you to get out of your living room and drive across town and come and wait in line or sit in this waiting room with sick people or whatever.

Erich Fogg:

And I had colleagues and friends all over the country that were starting to dabble into this and New England was relatively slow on this curve. So I thought I had this, I had taken a leadership course that was run through the state for healthcare providers and you had to do like a project, so as part of this leadership course. So my project was to be introducing this telehealth urgent care program in our community. Just to dip our toe in the water, and in 2014, when I thought about this, there wasn't these EMRs that had telehealth software embedded in it, so I had to go out to the market and try to find a HIPAA compliant. Remember Skype? Remember it was a connective tool before Zoom and all that Like Skype just wasn't going to cut it, if you knew what I mean right.

Erich Fogg:

So you had to find a HIPAA compliant. I found a little startup in Salt Lake City and we partnered with them. They were relatively low cost because they were new and we had a small project and I had to put together a training program for our providers that's. I think you'll find this cute. We're always taught bedside manner when we go to graduate school. I had to teach website manner. Oh, I like it. Yeah, just because you and I are talking now I could look at the camera and it looks like I'm looking at you If I look at the screen, like there's how you address people on video, zoom chats or whether I came up with protocols of questions to ask and all that sort of stuff, because I thought I just wanted to stay ahead of the curve, right, I wanted to offer something innovative. We live in a relatively small community. I even convinced we have a fleet of cars at our hospital that take people to appointments and that type of stuff. It's cool. It's a little bit of a throwback, but I convinced my pharmacy group and our transportation services that if you live within five miles of the hospital, I'd even run your script out to your house, right as a trial kind of thing to see how it goes.

Erich Fogg:

And, ashley, you know what happened. We put all this work in it and no one really came in. No one really, I mean logged online, no one. And we tried to market it a little bit. We tried to, so this was probably 2017. We started to go live with it and we'd get a little trickle here and there and it just was like I'm like what is wrong with it? I thought people would love this, people would love this.

Erich Fogg:

So, finally, I'm working a day and I see a gentleman who I see every year, who comes in with whatever complaint and it was a perfect complaint for a telehealth visit and I said, hey, we got you all squared away today, but let me walk with me. Let me show you this little room that we've built and the computers in here. And wouldn't it be cool if you just sat at home and you connected with me like you do FaceTime or anything like that, and I evaluated you and we ran the script out to your house. You never had to leave, wouldn't you think that's cool? And he I'll never forget this. He looked at me and said, wow, this is really neat, nice job with the technology and everything. But you know what? Your waiting room is so nice. You have coffee in here, your staff is really nice.

Erich Fogg:

I just like getting out of the house and coming in here and I'm like, oh gosh, maybe we weren't ready for this. But then COVID hit and because I had this stood up and when everything shut down within a nanosecond, I flipped it and we were all trained and we were all ready. So, by happenstance, it turned out to be a reallyosecond. I flipped it and we were all trained and we were all right. So, by happenstance, it turned out to be a really great thing. But I thought I failed. I thought I failed with this project and then the world changed and to this day, I keep it stood up. It's an option.

Ashley Love:

It's interesting because it's two situations here that I'm thinking of. Going back to Maria, who is your first student, that you that you helped pass her board exams. In that case student that you helped pass her board exams In that case, need was what built the innovation right. There was a need and you had an idea and you solved that and then you built this incredible program. In this case, the innovation came first and then the need was realized.

Ashley Love:

I think so many times we have these ideas and we really don't elaborate on them because it doesn't seem like there's a place for it or a need for it or a person that it could benefit. But if it's a great idea, like you said, put in the work, put in the effort, throw it against the wall a couple of times, see if it sticks Because hopefully we don't have another global pandemic, but maybe your global pandemic is just a couple of years away and then it becomes this fantastic, ready-made solution, innovative solution to the problems. Do you see anything coming down the pipeline with what's next with innovation? We mentioned telehealth, of course, like AI is such a big thing right now and I don't think that PAs or really any healthcare professional is going to be overtaken by a robot. But what do you see, what excites you about innovation in PA, in the PA world, or maybe even just medicine in general right now?

Erich Fogg:

I think to speak to medicine in general. I got an Oura ring for Christmas.

Ashley Love:

Fantastic.

Erich Fogg:

Wearables. I have the Apple watch. We all have an Apple watch Adding. I think the wearable technology is going to be game changing in the field of medicine and I think there's a lot of information that can be extracted as this technology even improves. So the Apple Watch is great and there's a lot of things it can do and they continue to, I think, innovate there and even can diagnose arrhythmias and all that type of stuff. What I find super cool about this Oura Ring is the sleep data right and the sleep points and all that type of stuff.

Erich Fogg:

I think, as we continue to evolve this type of technology, we can be more proactive in preventative medicine right. Our system is phenomenal at reactive medicine right, treating conditions right. Wouldn't it be great if we just help people not get sick right? Or chronic disease management and that type of thing? So I see that really is something that's accelerating. It seems like that's catching a lot of momentum.

Erich Fogg:

Ai is super interesting, as I think that will be part of. I think even things like even doing. We've dabbled with scribing using AI and technology where there's still this exists, where you could bring a scribe in the room like it's a person right, they're capturing your notes, but now AI scribes and stuff, where it's just the technology and the software listening in and that sort of thing. You get on Zoom meetings now all the time and there's an AI note taker right, capturing the notes and all that. So I think what we are challenged with correct me if I'm wrong, I think you'll agree is the paperwork and all these challenges of documenting and all that sort of stuff.

Erich Fogg:

And we're feeling as healthcare providers. Sometimes we get disconnected from the patient care because we're looking at a screen all the time. Right, can even advances in innovation improve that part of our life and allow us to better focus on patient care? Right? Can we use wearable technology to predict when patients might be getting sick or might be starting to have exacerbation of their heart failure or other chronic medical conditions? So I see that as the area in medicine. I think PAs have positioned themselves as leaders now we talked about in leadership position to help bring those changes to fruition in your practices, in your systems, those types of things. So I think we have a role in that will be really important going forward.

Ashley Love:

I agree. Those are two really excellent examples, and thank you for talking about wearable technologies as a good tool, not just one that spies on us and tattles on us to our providers, because that's not what it does. Sure, eric, thank you so much for joining us today. In closing, you have had so many incredible experiences as a PA in healthcare and you have worked with so many, I'm sure, incredible healthcare providers as well. You've also trained a lot of students and have worked in education for a really long time. So, with all of that, in your opinion, what qualities do you believe make a fantastic healthcare provider?

Erich Fogg:

Yeah, wow, that's a really great question. I have changed a lot as a provider as I've grown in this profession and I'm always reminded of when we see patients. It's often at their worst or one of their worst days, right, and I'm often humbled by that process that what an opportunity, what a gift it is to take care of someone when they're coming in to see you when they're at their worst. So it always grounds me in that process of remembering our role in this whole system of health care, right, as health healthcare providers. And I think it's listening, I think it's empathizing, I think it's validating what they're saying. Sit down in the room when you take a history, right, don't stand up and look down at your patient, right, sit down, get eye level, make eye contact right, maybe put a hand on their knee or something like that. That they're listening.

Erich Fogg:

And I do a lot of coaching and counseling to our providers and new grads. We have things like Press Ganey and we could talk about that for hours, right, patient satisfaction scores and that type of thing. But really it's not to me about the Press Ganey scores as much as it is when patients write in these narratives about their experience on our service line that I'm most proud of and I send that to our CEO and I send that to our community. Yeah, you come into our service line and this is the experience you get and to me it's just about being genuine, it's being caring, it's being nice, right?

Erich Fogg:

I always say when I hire staff, I can train you. I've been doing this long enough. I can teach you to read a chest x-ray and EKG, I can teach you the suture, but I can't teach you to be a nice person. So I hire good people and I can train the skill I might have, the most talented, skilled person, but if the other pieces aren't there, I found it's not always the best hire. So be a good person. How about that?

Ashley Love:

That's great. I think it's perfect. It's the whole point of chatting with you and with all of the other amazing healthcare professionals is we just want to keep the humanity in medicine. That's why we got into it in the first place, and I think there's so many challenges that are being spoken about right now. It's those successes that I really want to talk about. Eric thank you so much for spending time with us on.

Ashley Love:

Shadow Me Next. I cannot tell you how thankful I am for everything that you have done as a PA for our profession.

Erich Fogg:

What a great platform you have and congratulations to you for your success with this and keep doing that. Great Proud to be here, thank you.

Ashley Love:

Thank you so very much for listening to this episode of Shadow Me Next. If you liked this episode or if you think it could be useful for a friend, please subscribe and invite them to join us next Monday, as always. If you have any questions, let me know on Facebook or Instagram Access. You want stories you need? You're always invited to Shadow Me Next.

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