This month’s PA Profile features rural health care provider Susanna Storeng, DMSc, PA-C, DFAAPA, CPAAPA, who is Chief Clinical Officer of a federally qualified community health center (FQHC). Dr. Storeng became medical director at High Plains Community Health Center (HPCHC) in rural Southeast Colorado in January 2020 and was later promoted to CCO overseeing all clinical departments (medical, dental, and behavioral health) in August 2021, during the height of the COVID-19 pandemic. Dr Storeng continues to practice clinically in addition to her administrative duties.
Q: What led you to pursue a leadership role at an FQHC?
Dr Storeng: I have been involved in advocacy and leadership to some degree since I started PA school at Pennsylvania College of Technologyin 2001. As a PA, we are on the front line of care and FQHCs rely heavily on PAs/nurse practitioners (NPs) to provide care to patients because of our ability to be flexible and adaptive to many areas of medicine. But the mission is the reason that most of us work in community health. Caring for underserved communities and providing care to persons who might not otherwise be able to seek quality, accessible care is very fulfilling.
My progression into leadership was a continuation of this mission for me. I saw administrators who did not understand the mission or the organization and wanted to make a change. Transformational change requires living the mission and that is what we do in community health. Advocacy, as I mentioned, has also been a significant role for me and this is a major part of my leadership role at HPCHC in Southeast Colorado. Thus, it felt like a natural transition. However, it has not been easy. Transitioning into the leadership role just before the start of the COVID-19 pandemic and leading as the CCO through the past 2 and half years has been difficult and time-consuming to say the least.
Q: What are the biggest health challenges facing your community?
Dr Storeng: In rural health care we always struggle with the retention of health care providers; unfortunately, like so many health care organizations and other industries during the pandemic, our community has been experiencing the “Great Resignation.” Both providers and support staff turnover and consistency have been a major struggle. Additionally, the social determinants of health are a major challenge in rural communities and our community is no exception. Particular areas of concern in our community are education, employment, income, housing, transportation, walkability, hunger and access to healthy options, provider availability, social support, and community engagement.
Q: What is one of your most memorable patients?
Dr Storeng: I have so many patients who made an impact on me over my career that it is hard to think of one favorite. But I love when patients have wins. So often patients feel lost when they have a new diagnosis, they are scared, stressed, confused, anxious, and often feel helpless. When these patients have major health outcome wins, they experience a complete turnaround in those feelings.
One particular patient came to me for damage control. This monolingual, Spanish-speaking young man in his 30s had seen another provider with only his bilingual wife to interpret for him. He was found to have new-onset type 2 diabetes after presenting with redness and discharge under the foreskin of his uncircumcised penis. His hemoglobin A1c (Hb1c) was 11.9%! The previous provider told him he had diabetes and sent in a prescription for metformin extended release 500 mg twice daily. A health coach then came in to talk to the patient, gave him a glucometer and showed him how to use it, and told him to check his blood glucose level twice daily and eat fewer carbohydrates. The patient was terrified. He had many questions and thought he was going to die.
This gentleman and his bilingual wife came in to see me the next day and we used our staff medical translator to help explain what type 2 diabetes is and what it is not (a death sentence), and how we could work to get to under control. We got him aligned with a dietician; we took the time needed to educate and empower him on how he could control this condition. I also started him on basal insulin that day and explained that if we could get him out of glucose toxicity and work on lifestyle change, we would be able to stop the insulin.
At 3 month follow-up, he had worked diligently on improving his physical activity, decreasing his intake of carbohydrates and sugary beverages, and monitoring his sugars. His A1c was 5.3% and we started weaning the insulin. That was 5 years ago. Now, his A1c is still in his goal range (6.9%) and he is not on insulin, despite some loss to follow-up due to COVID-19. Taking time to hear the patient and be there for them is a great reward.
Q: How do you prevent/manage burnout?
Dr Storeng: Prevention and management of burnout is a huge burden in health care in general and my health care colleagues will agree that as clinicians and leaders we are not immune to it. Although we try to prevent and mitigate the effects, we still get burnt out. One way that I have managed burnout is to delete work emails from my cell phone; I also do not bring my work laptop home. I limit my patient documentation to the office. If I am behind on my charting, I will stay a little later at the office or go in a little early, but I will NOT take it home.
Taking time off is essential to fill one’s cup as well. And, when off, I must be off. If I accept calls from the office, I am telling my organization that my personal time is available to them and that is not acceptable. Regular sleep, exercise, and breathing exercises/meditation also help with stress management.
Q: Is there anything else you would like to tell our readers?
Dr Storeng: As a second-generation PA (my dad became a PA in 1978 and practiced until 1985), I am a proud PA and feel very strongly that we need to self-advocate; including growing a large lobby to better promote our profession and gain national optimal team practice. Optimal team practice occurs when PAs, physicians, and other health care professionals work together to provide quality care without burdensome administrative constraints. As PAs, we are trained in general medicine and we have a broad base of medical knowledge but the restrictive nature of many states’ legislation does not allow PAs to practice to the full extent of their education, training, and experience. This has direct negative effects on health care access and outcomes for our patients. I urge all PAs to advocate for their patients and their profession. PAs are highly trained and this has been qualified by national examination and certification standards, initially and continually. PAs are committed, dedicated, and perform high-quality services. I tell my PAs: Do not ever sell yourself short. You serve a great purpose… the health of your patient.