Mary Showstark, MPAS, PA-C, on COVID-19’s Effect on the Future of the PA Profession

Mary Showstark, MPAS, PA-C, has worked in trauma surgery, emergency medicine, urgent care, and disaster preparedness for the federal government in numerous locations, including Los Angeles, Maui, New York City, and Miami Beach, where she lives. Mary has also spent many years working in event medicine and for athletic organizations, including the World Surf League, Burning Man, and the U.S. Open Tennis Championships. She has traveled to more than 100 countries on all seven continents. In addition to working as a physician assistant, she is certified in massage therapy and yoga and teaches problem-based learning for the Yale PA Online program. We recently spoke with Mary about the global lessons we’re learning from the pandemic and what the future of large-scale events might look like.

Every day I stick to a routine. I wake up, I meditate, and since I can’t go to the gym, I get online and join a boot camp on Instagram. A lot of mornings I have meetings with the World Health Organization (WHO) and EPI-WIN (WHO’s Information Network for Epidemics) regarding what’s happening in different parts of the world. Those are usually early in the morning because they’re based in Geneva. 

On the calls we discuss what countries are doing during the crisis, the status of the health care workforce, and what is happening globally. I represent Physician Assistants for Global Health (PAGH) on these calls. I am also a part of the Global Association of Clinical Officers and Physician Assistants (GACOPA), and I’m on a group chat with about 500 different providers who are physician assistant equivalents. We exist in 56 different countries under 14 different names. Our umbrella term is “accelerated medically trained clinicians.” If I have information from these calls, I disseminate it to those groups.

The rest of my day is dedicated to working with the Yale Physician Assistant Online program. I have created the virtual interprofessional education (IPE) site, which is very relevant now that every program is online. I also created a COVID-19 case study that PA professionals can access on the IPE site and use to discuss best practices, strategies, and ways of coping during this time with providers from all over, whether it’s Yale University or the University of the Witwatersrand, Johannesburg. 

We’re lucky that our program has been online for three years, so unlike other programs, we didn’t have to cope with the disruption of quickly taking a program online. We’re fortunate to have a combination of asynchronous content that we already built and to have synchronous content and problem-based learning environments for our students.

I’m heavily involved with WHO on the health care workforce. By 2030 the United Nations has a goal to have health care workers everywhere in the world. And I believe the physician assistant workforce can help fill that gap by 2030. 

I’m on the board of PAGH and am a global ambassador to the American Academy of Physician Assistants, and I’m on the communications team for the International Association of PA Educators. I set up a meeting for educators to discuss strategies about teaching online during COVID-19. We met for the first time on Zoom about three weeks ago. We had many different countries join us including South Sudan, Liberia, Somalia, India, Germany, the UK, Canada, Australia, India, Bangladesh, Malaysia. We actually had the Physician Assistant Education Association (PAEA) join us as well. They helped out by sharing materials and strategies that educators are using in the United States. 

Another exciting development is that WHO has offered to join us for an upcoming meeting. This is an important recognition of the PA workforce, which is something we have been working for.

I think mitigation and proper preparedness starts at an individual level. As individuals, we must ensure that we have our own proper supplies to take care of ourselves in a crisis. Providers should be aware of where to get supplies and should have a personal stockpile. As providers, we should always make sure that we’re participating in hospital drills, simulations, and tabletop exercises. We should understand our hospital mass casualty incident plans and surge drills and what to do in surge capacity.

Many people and providers are confused during this time, and rightfully so. There are a lot of misconceptions about the strategic national stockpile. In reality there are many levels that should be prepared for this. As I said, we need to take our individual responsibilities by having our own supplies but we should also have individual stockpiles from our hospitals, at our clinics, at the city level, at the county level, and at the state level before we reach the federal stockpile. 

The responsibility for training starts at the individual level. OpenWHO.com is WHO’s new interactive, web-based, knowledge-transfer platform offering online courses on COVID-19 to teach you how to explain things to your patients. As providers, we should be proactive in looking for sources, finding answers, and, just like we tell our students, leveraging evidence-based medicine. While we don’t have a lot of evidence-based medicine on this virus itself at the moment, we certainly can research what’s happening with testing, help shape hospital protocols, meet with managers, and ask good questions.

I’ve increased my advising appointments with my students. Every time I meet with students, I encourage them to share stories—the good, bad, funny, and sad. I encourage them to think about things that they’re grateful for. During finals week, I had my friend Lane Carlson lead a tactical breathing workshop for our students on Zoom.

When this crisis hit, I was asked by a colleague who works in northern Italy to speak to a group of high school science students there. I told them what I told my students here at Yale: Focus on what you can change and focus on what you can do to make the world a better place. If you see something that you think you can fix, try to fix it. Reflect on what would you have done better in certain situations—how you could handle situations differently? It’s a bit of problem-based learning, but I encourage them to focus not on the negative but to focus on the positive.

I think from these experiences you can learn that there’s a lot that you can plan for; however, there’s a lot that you cannot. There have been pandemic plans, such as the one that was established after the SARS outbreak in President Bush’s time, but it takes participation from everyone from who’s working; it requires improvisation. You have to understand your mass casualty protocols, your surge capacities. You have to work within crisis standards of care. It’s trying to do the best you can with limited resources. 

So, we might have to reuse N95s; we might have to work in conditions and use supplies in ways we don’t typically use them. I think you have to stay open-minded and positive in these situations. You can’t point fingers or place blame. You have to recognize when you’re working in disaster that we’re all in this together, and you do whatever you can to support your team and pull through.

I think people will be a little timid to attend large-scale events initially. And I think there’s going to be a lot of personal as well as infrastructure changes. One of the things that could potentially happen is that before attending, people may be required to report which countries they have visited, whether they have had a fever—the sorts of questions required when you arrive on a flight from other countries.

There could be the potential for thermal scanners, such as the kind they have in the Jomo Kenyatta International Airport in Nairobi, that detect your body temperature. It’s hard to say because this virus is very unique in that it can stay in the body and you can be asymptomatic. We don’t know enough right now to say if it can resurface like viruses such as herpes that come back again and again.

I think there’s going to be particular attention to fogging—cleaning airplanes and facilities with sanitizing spray. People may bring their own cleaning supplies to events and wipe things down. You might see more people in masks. In the short term, we will likely see more spacing and distancing measures. For instance, certain airlines are saying that they’re keeping the middle seats open on their flights.

I believe we will get past this disease, and I think there’s going to be a greater need for public health and the capacity for public health providers to monitor who’s at these events to be able to do really good contact tracing.

I worked in trauma surgery for many years, and I find you have to ground yourself and find that inner happiness, as cheesy as that may sound. I dealt with many people who were in car accidents and who became paraplegics and couldn’t walk—some of them became motivational speakers, and some of them became really angry. 

It takes work to try to come to terms with yourself and your coping mechanisms, especially during this time. I think it’s being true to yourself and identifying and naming your emotions, whether it’s panic or anxiety or feeling sad or angry. Recognize and try to figure out how to control those feelings. That’s where I recommend things like meditation, gratitude, and breath work.

Being inside these masks all day long, it’s hard to take deep breaths. You have to find those moments where you come back in and strengthen your lungs, do breath work, and recognize what’s truly important.

Sometimes in a disaster setting you have this feeling that everything’s on your shoulders and you need to fix everything. There’s a lot of pressure to do more and work harder. But you have to realize you can’t do everything, and you must be kind and take care of yourself, too.

I think we’re going to have a greater look at stockpiling preparedness and health care communications, and I think there’s going to be a big look at county, city, state, and federal emergency preparedness. We need to recognize where and how we can improve, and as I said before, that includes individual preparedness and finding out what you can do as an individual to make the system better.

Citation for this content: Yale School of Medicine Physician Assistant Online Program