From Policy to Patient Care with Deanna Bridge Najera

In this episode of The Well, Mary and Leanne sit down with Deanna Bridge Najera to discuss advocacy, health equity, the evolving role of PAs, and more. From legislative wins in Maryland to meaningful patient connection at the bedside, Deanna shares how passion and purpose can drive lasting change.

Transcript

SPEAKER_00 0:07

Welcome to the PA podcast, The Well, brought to you by Mount St. Mary's University PA Program. This is a source of insight, inspiration, and growth for current and future PAs. My name's Mary Jackson, and I'm the founding program director for the PA program, and I'm joined as always by my esteemed colleague, Dr. Leanne Hedges, our founding associate program director. Today we're joined by one of our esteemed guest lecturers, Deanna Bridge Najira, past president of the Maryland Academy of PAs, a practicing emergency medicine and reproductive health physician assistant with over 15 years of experience across emergency medicine, psychiatry, and public health. She holds dual master's degree in physician assistant studies and clinical mental health counseling and has earned certificates of added qualifications in both psychiatry and emergency medicine, and is currently pursuing a doctorate in public health. In addition to her clinical work, she is a national leader in the profession, serving on the board of directors for the American Academy of PAs and is deeply involved in health equity, addiction medicine, and education at both the graduate and national level. Her work spans everything from emergency department care to sexual health, substance use disorders, and bias in health care, making her perspective especially relevant to the future of PA practice. Welcome, Deanna.

SPEAKER_02 1:27

Thank you. That is quite a bio. Thank you.

SPEAKER_00 1:30

That is quite a bio.

SPEAKER_02 1:31

Makes me sound like I've done it.

SPEAKER_00 1:32

Very impressive. It's amazing. We're really honored to have you here. I was fortunate enough to be in the lecture hall recently as you were presenting to our cohort. And I feel like when you were done, there was like a mile-long line to talk to you afterwards. So that's always a very good sign that everyone is really engaged.

SPEAKER_02 1:51

Yeah. No, it's it's great to see. And what I love about this, you know, upcoming the recent graduates from PA programs is they are have a much bigger view, I think, than I did when I was a student of that interaction of not just the person in the exam room, but outside. What are these system issues? And I love to see that. And I think they're already leaps and bounds ahead of where I was when I graduated.

SPEAKER_00 2:11

I feel like I say that all the time. I feel like I went into PA school and I was fairly dear in the headlights about like the broad strokes of what's going on in healthcare right now and what's going on with the profession or the education behind the profession. Um, and these students are very well informed.

SPEAKER_02 2:26

Absolutely, absolutely. It's great to see and exciting to see where they're going to be in five and ten years, too.

SPEAKER_00 2:30

Oh, very much so. So I'd like to kick things off. You've worked across emergency medicine, psychiatry, reproductive health, and public health. How has that shaped the way that you think about patient care?

SPEAKER_02 2:43

So I think this is actually just because those are my jobs, but this actually lends itself to being a PA, right? Is that we have that broad training, but also the experiences we have before we come into PA school. You know, that that required experience goes a long way of creating really broad, you know, differences of opinion, different experiences, that then we educate each other as students. Um, and then when we come out, you know, it really helps to keep an open mind and see the whole patient and then see those larger issues that are impacting the patient, both the reason for being there is what as well as what's going to influence their health when they leave the exam room. You know, what's the next stumbling block or hurdle that they have to overcome? And so I think pulling those things in really makes a well-rounded provider, which helps us provide well-rounded care to our patients.

SPEAKER_00 3:24

Yeah, very well said. I think PAs do wear a lot of hats and just recognizing the broad picture instead of the single moments of the encounter is really important. All right. So something that I know that I want to talk about. Um, you've done a lot of work in health equity and bias, which is something that you know we as a program pride ourselves on, right? We have an entire course series on it. We do exposure experiences. Um, what does that actually look like at the bedside, not just in theory, when we're talking about bias and healthcare equity?

SPEAKER_02 3:53

Yeah, so I think that this is recognizing that even as a healthcare provider, we have a certain level of privilege, right? We're coming in with a level of experience that not everybody has, you know, being on this side of the curtain kind of situation. Um, and then also we we have a job that pays well. You know, we're guaranteed a job, we're always gonna, you know, find a place to be, but we're also educated. You know, we all have had a college degree, we have all had a master's degree, which again, not everybody obtains. And we are fluent in another language. We're fluent in the language of medicine, which again is is something, again, that not everybody has and really holds. So, you know, I think that's we have to recognize that authority that we're granted, whether we feel like we've earned it or not, we're granted that authority is in the moment. And then it's the added level of I'm a white provider, you know, and so I need to own that privilege in the moment. And when appropriate, sort of broach that with the patient provider interaction. Um, and that may be as simple as a question of just help me to understand what challenges you're encountering, you know, what might get in the way of you getting this prescription or taking this medicine as prescribed or following up with this specialist. And it's really sitting with a patient and recognizing that their journey is their own. And while I can empathize, I can't really ever truly get it. So I just have to sort of be with them in the moment. And I think that that feeds back to reducing burnout to an extent. You know, if I'm trying to force somebody into a box or get frustrated that somebody's not doing what I told them to do, it just lends to me getting more upset in the moment as opposed to just sort of sitting and experiencing and being with the person. Um, and that's that's taken, you know, an arc for me too to get to that point. But it really helps me feel like a better provider, feel like a better human, you know, in meeting the person where they're at. And I think it improves their health outcomes when we can sort of empathize and recognize these are your barriers and what can we do now to help, you know, solve some of those or at least help, you know, mitigate some of those.

SPEAKER_00 5:45

Yeah, I think that's that's really important work. And it's hard, I think, for our students, right? They're working on surviving didactic care, surviving clinical rotations, right? But to get to these deeper levels to acknowledge the layers that are at play here for each of our patients. And like you said, this is not a personal attack if you're non-compliant with this plan that I've explained to you and tried to get you on so many times, right? Our patients want to be compliant, our patients want to have great health outcomes. It's us going the distance and figuring out how to support these patients exactly where they're at.

SPEAKER_02 6:19

Absolutely. And nobody wants to come to an appointment to feel shame, right? Like being a bad person, being a bad, you know, a bad patient. Nobody wants to feel that way. And that's why they avoid health care. And then when they do show up, their disease process is more advanced and they get treated even worse, and then they have even worse health outcomes. So, you know, if we start at the very beginning of having those better interactions, it improves health care, you know, for the patient as well as overall, like all the metrics that we have to check box. You know, if we explain, if we understand, if we meet them where they're at, we find out what their barriers are, um, it can go a long way for in a lot of different avenues.

SPEAKER_00 6:52

I just had a very good conversation with a student about what happens in healthcare when people have very diverse beliefs. And where we ended the conversation was it's not so much about what you believe, it's how you make the patient feel and what you're able to achieve for the patient. And and the word that we used was shame, right? We can't ever make our patients feel shame. Yeah. It's powerful. Absolutely.

SPEAKER_01 7:15

But I love how you say too um the prevention of burnout, because I find in my own career, um, some of the ways I found to really thrive are breaking down those barriers and that wall between clinician and patient. Um, so I think connection is key here.

SPEAKER_02 7:32

Yeah, yeah. And that's where, you know, sure, like all these wellness initiatives and stuff like that are like, oh, we'll have more pizza and get massages and contact your EAP. But it doesn't, you know, it's it's we're talking about a system level, you know, and and and hitting your head against the wall just gets so frustrating. But having that human connection, you know, filling your cup with those interactions can go such a long way. Um, because that's really why we got into this. You know, if you ask anybody, like, oh, I want to help people, what genuinely helps people is feeling valued, feeling heard and recognized. And that goes both ways. You know, when I can tell you all of the thank yous I've gotten as well as the complaints, you know, but we hold those dear because it's a it's a connection. We felt like we did something worthwhile. Um, it's not just the good catches, it's the time that we felt like we were present and we were heard and valued and respected both directions. And think about yourself when you're a patient. You know, what are those providers that you were like, God, I want to be like that person? Why? Because they were there with you in the moment, right? Like they, they've you felt heard, you felt respected, you felt valued. Um, so if we can be that same sort of connection, it goes a long way to improving health outcomes as well as improving our own wellness.

SPEAKER_01 8:38

Well, I think you said it perfectly that we sometimes forget we speak a different language or we're keyed into this language of medicine. So, how do I say it in a way that you understand?

SPEAKER_02 8:48

Yeah, yeah, absolutely.

SPEAKER_00 8:50

So, thinking on all of these issues, right, there's so much we can do as advocates for our patients, uh, for our profession. I know you're incredibly involved in that. I feel like in my career, I've had the privilege of knowing you, and you've brought me into the fold in these next steps, this greater awareness activism. Um, you know that we teach this in our professional practice series, but um, what advice would you give students who are becoming aware of all of these different um issues at play, both for patients and the profession and healthcare in the United States, but also they're brand new in what they're doing. So, what advice would you give them as they move out into clinical practice?

SPEAKER_02 9:28

Yeah, and it's it's hard, right? Because you, like you said, they're just trying to memorize like what's a friend sign and what's the antibiotic and and how do I do this maneuver? And it's yes, that's you know part of it, but like you can always read up on that, right? You can always relearn those sorts of things. But sort of keeping your passion at the center, at your your core, you know, what is your calling, I think goes a long way. And so when we talk about directing that advocacy, I that's what I get back to. What is the patient that stays with you? What is the thing that you read about and learn about when you don't even have to? What are those sorts of things that you're really interested in? Because whatever your specialty is, you'll sort of drift into almost a sub-specialty or a small component of that. You know, who do you end up spending more time with? What do you end up Googling afterwards, you know, and really getting involved in? And that again sort of fills you. It it gives you a sense of purpose. And then you can apply that to larger system issues because, you know, people say, well, we need to fix healthcare. What does that look like? You know, like nobody, no country has, yeah, and no country has a perfect healthcare system. So, you know, yes, it seems incredibly overwhelming to be like, well, I can't fix any of it. Yeah. And that, you know, frustration, you kind of roll over and then you beat your head against the wall again, right? Like you get up against it. But are there small periods or or pieces or or populations that you're really like, no, I want to see this different? And that might be broad, you want to see practice better for PAs, or it might, again, be a population that you're passionate about of I want to work on this. This is the thing that I want to own. And maybe that's small. Maybe that's going to your, you know, high school education and the family life committee or the board of education and just educating. Maybe that's reaching out to a women's group or a men's group or a parents' group or something like that, or, you know, a survivor group of whatever disease process, you know, and you lend your time and again using that expertise. You know, if you have a kid with cystic fibrosis, do you join the National Cystic Fibrosis Society and give a, you know, a clinician perspective? Do you join a domestic violence survivor group just to provide support in that avenue? And again, it sort of feeds back in on itself of you're helping other people speak the language, you're offering your expertise in helping lift, um, as well as just being there for the individuals that you interact with. Um, and that's where I sort of fell into advocacy of being like, well, this is frustrating me and I don't understand why this rule is here. Okay, well, what can I do to change the rule? Well, I can go to this meeting, I can talk to this person. And, you know, bit by bit, it seems little, but it's also like, man, we changed a law. Like we literally changed a law. So, you know, you can make this happen. And that's what I love about this, you know, upcoming activist sort of population of like they can make a change and they recognize that. Um, and I just want to sort of give them the guidance of how to do it in a way, way that's mindful as well as broad, you know, of sort of looking at all of those ripple impacts that you can have, needing to be aware that because PAs are a small group, when you speak as a PA, you're seen as speaking for all PAs. And so you sometimes have to be really careful of like you say, oh, PA should do this, or are trained, are you unfortunately negatively impacting other PAs working in other settings or with other populations? So I think holding, again, the community at the center is so incredibly important when you do these kind of conversations.

SPEAKER_00 12:39

I appreciate that. One of the things you mentioned in there was success. Um, and we're coming, you're coming off the groups that you support and lead, the profession is coming off of a big success. Do you want to talk about that?

SPEAKER_02 12:52

Yeah, so this is our second major legislative win in the last three years. So in Maryland. So in 2024, we had the PA Modernization Act, which was the biggest overhaul of our practicing legislation in almost 20 years, which really sort of we had some archaic language left, um, and we're trying to update that. So we moved to a collaboration agreement. And then this year, what we did was sort of a fixer. Um, so this is the PA Parity Act. And basically, we have statute that is purely about how PAs practice, but there's all these other spots that healthcare providers are mentioned. And the problem is that we need to go in and fix every single place. And so we had 22 different areas within the legislation that we wanted to add PAs where nurse practitioners and physicians were listed and we wanted to add PAs, and we were able to pass 20 of those, which is pretty cool. Um, and it's it's you know, some of it's you're done, you're like, what? How is this even a thing? It's like, well, it got written in at one point, however long ago, and now it needs to be fixed. Um, so it's neat to see that process come along. And the neat thing is that even those two aspects that didn't get passed, we now have conversations pending. You know, we're gonna talk to the Maryland Healthcare Commission. We have meetings with other, you know, Medic, the Maryland Medical Society, which is MedCHI and the Board of Physicians, of sort of how can we approach this again in a way that's mindful, that's creating, you know, partnerships and coalitions and looking forward to what our next steps are. And this is where, you know, we need people. We need people that are willing to tell their stories, talk about their pain points, talk about their successes and challenges, and that are willing to spend an afternoon in Annapolis, um, you know, talking to the representatives and stuff like that. So we're hopeful that we're gonna have some more engagement. You know, it people get fired up when they see wins happening. Um, so hopefully we'll have opportunities for students to continue to be involved. And I know we had a representative from Mount St. Mary's come, which was great to see the schools represented, and hopefully we'll have more opportunities for that in the future.

SPEAKER_00 14:43

That's amazing. Can you give our listeners an idea of some of the things that were in the Parity Act?

SPEAKER_02 14:49

Yeah, so it, you know, it's some of it seems kind of random. So, for example, you know, PAs actually couldn't write for um epineprin auto injectors, so epi pens uh for summer camps. Uh, because we have to have a relationship with the medical director of the summer camp. That was the old sort of thought because we were acting in a supervisory role. But since we now are a collaborative role and also just the idea of like summer camps need to have epi pens, like this is an emergency, they're outside. Yeah. And so we can, you know, so we can now write for those, which again required a change in the law so that we could do that. Um, we can also do competency assessments um for individuals under guardianship. Um, there's also um some avenues for, I'm trying to think of all the all the different spots that we had. Um, you know, so it's it's one of those sorts of things like they seem small, but they make that ripple impact. The other thing that was interesting about this year is we also were able to support some other legislation. So it didn't explicitly mention PAs, but for example, we wrote a letter of support adding bacterial vaginosis to the list of things that we can do for expedited partner therapy. Um so that means when you see somebody, you can now treat their partner as well in an effort to reduce infectious diseases. Um so right, yeah. So, you know, this is the neat thing about legislation. It's not just what we're writing about or what we're we're advocating for, it's this broad sort of how can we also support other things that we're passionate about? Um and so we'll have a nice little summary letter that'll be coming out, um, and then we'll continue to move this work forward.

SPEAKER_00 16:20

Awesome. I was talking with some students because they've been very engaged with the professional practice aspects of the curriculum. And the talk is, well, what's next? What's on the horizon? Is it the coming back? Is it moving towards independent practice with or without bumpers? Like what do you foresee is next for Maryland?

SPEAKER_02 16:38

Right. So, you know, this is a challenge because we are always keeping the patients at the center, right? Like that is always our primary goal, is keeping patients and patient safety. You know, we are not in the interest of harming patients or creating harmful situations. So, you know, collaboration is still high on our list. Maryland remains the only state in the country that has a separate list of advanced duties, um, which is this idea of having to apply for special permission. We really want to look at keeping that on the practice level. This is a decision between you and the team that you're collaborating with based on your training, education, and experience. And it's a challenge, especially as we change specialties, or sometimes we're hired specifically because of our experience to broaden the scope of a practice. And yet we're limited in the sense that we can only do what our supervising or collaborating team is allowing us versus our own education. So we're looking at those sorts of avenues. And then, of course, the challenge is always we can have this plan, but it really depends on what happens, you know, at the state and federal level of that suddenly there's a bill that we have to sort of drop what we were doing and pivot to focus on that because it really can impact us in a negative or a positive fashion, and that we have to sort of focus on that. But we're definitely gonna bring back those two areas that were not passed this year, which is regarding involuntary and voluntary commitment for psychiatric emergencies. We think that that's really an important component of our practice, as well as again for patient safety, reducing emergency department boarding, um, and some other really components that have been of paramount importance to the legislature as well as the hospital association. So we're gonna try and find some ways to, you know, uh partner on that and move that forward. But this is also where we want to hear from PAs, you know, what are your challenges that you're experiencing so that we know we only represent what we work in. So we need to know where you work, what are your challenges, and how can we focus on that? So we hear a lot from dermatology on the challenges that come with that, again, because of these advanced duties and some other Comar regulations. Um, so we're we're kind of keeping our options open and laying groundwork not just for this next year, but years to come as well.

SPEAKER_01 18:41

Well, I'd love to ask the question on my mind, which is what are your thoughts on Maryland joining the licensure compact? And do you foresee that happening?

SPEAKER_02 18:49

Yes, we would absolutely love to do that. Um, and that would definitely be something that would help a lot, particularly because the way Maryland is shaped, we have a lot of borders, you know, and things like that, and a lot of people and patients that live or work, you know, and go across the state lines and having that compact will go a long way to be able to, you know, continue the continuity of care. And then we have the rural transformation grant, you know, and so really making sure that we are allowing our PAs to practice to the full extent of their licensure in all settings, you know, and that includes all the way out in the west, all the way on the eastern shore, you know, these areas that are are historically and continue to be very much underserved. But PAs face particular challenges when you don't have a collaborating physician that's close by, or you know, you're trying to do some team-based care with specialists, specialties to, you know, kind of continue that care and advance it. Um, we need to find ways to make that happen. And unfortunately, sometimes this is also the local individuals not recognizing what limits actually exist. They think, oh, I can't hire a PA because of this. And it's like, well, actually, that's not true. You know, you mentioned dependent and independent, and we are collaborating. You know, it's that's a it's really the the source of the word is important because we can work in a lot of different environments. We have lots of hats that we wear, and we can really advance care wherever we're at. You need to hire us to do that, as opposed to thinking that we can't do certain things.

SPEAKER_00 20:11

So um at the end of each episode, we like to ask our guests to plant a seed at the well for the next generation of healthcare leaders. So, what pl what seed would you like to plant?

SPEAKER_02 20:22

So I I'm glad I heard this ahead of time because I was like, oh, so many seeds, so many seeds to plant. Um but I think I'm actually gonna take something that I was asked once that just really resonated with me was sort of what keeps you up at night? Um, you know, and sort of, and I was like, when I first asked that, I was like, well, the list is long, you know, of all the things. But I think that that for, you know, particularly newer to practice individuals of sort of what are the things that you're sort of dwelling on, or again, those those patients or those problems that stick with you. And then I extend that question, not just what keeps you up at night, but what are you going to do about it? You know, what what do you feel like your role is in that? Is that just to give the best day and care that you can in the moment? Cool, awesome. You know, become the expert in your practice, in your specialty, you know, lean into that. That's that is that is good. We need that. But is it also fixing some of these system issues? You know, is it showing up? Is it raising your hand? Is it taking that seat at the table even when it feels uncomfortable and sort of saying, you know what? No, I I do know something about this or I am passionate about this, I want to see this different, and then engaging in the solution. So I would, you know, find that mentor, find that pace setter, you know, somebody that you can sort of follow or somebody that can support you as you move forward. Um, and then just go ahead and do it, lean into it, you know, make those changes happen.

SPEAKER_00 21:34

I love that. I think that certainly summarizes your career. You followed your passions. I've had people ask me, like, how did you get in these leadership roles? And it's like, I never intended to. I'm just very passionate about certain things, so many things. And then you wind up in these spaces. So there you are. Yeah. But it's it's an honor and a privilege. So thank you so much for joining us, Deanna. Thank you, Leanne, and thanks to all of you for listening. We can't wait to meet you back at the well.

SPEAKER_02 22:00

Much. This was great. Thanks, everyone.