As a physician assistant neurological surgical first assist in Anchorage, Alaska, Jeff Stubblefield, PA-C (Anchorage Class 2) sees a lot of unmet medical needs in the Alaska Native population. “Underserved is the word, but I don’t know that it captures all the issues we have here,” he says.
An employee of the Alaska Native Tribal Health Consortium (ANTHC), which provides health services to 130,000 Alaska Natives and American Indians, Stubblefield is clear about some of the challenges. Weather, for one. “There are a lot of obstacles we face trying to care for this population,” he says. “When it’s wintertime here, I can have somebody with a ruptured aneurysm sitting in cold bay for three days.”
Another challenge is the lack of specialty care — and the time it can take to arrive at the right diagnosis. Prior to receiving a recommendation to visit the Alaskan Native Medical Center in Anchorage, most patients have traveled a long road for relief of their symptoms. By the time Stubblefield sees some patients at the center’s neurosurgery clinic, they may have had to see several healthcare professionals, from a health aide in a remote village, to a mid-level or physician at a regional clinic.
Even in instances where the need for neurological services is identified immediately, accessing care can be difficult.
“I’ll get a phone call from Savoonga. They’ll say they have somebody who fell down, and they’ll diagnose paresthesia or myopathy,” says Stubblefield. “And I can expedite those to a certain extent, but the geographic space of Alaska, weather, transportation obstacles, and the limited services available to the patients all work against speedy access.” In fact, medivac planes trying to fly patients out of rural communities sometimes have to wait days due to snow, rain, wind or fog.
Interestingly, although Stubblefield sees a variety of cases at the center, he’s noticed a high incidence of aneurysms within the Alaska Native population. “It’s extremely high up here,” he says. “It was something that I wasn’t quite prepared for.” In the past three or four years of practice, if Stubblefield finds one aneurysm — whether it’s ruptured or an incidental finding — frequently someone else in the family has had one as well. Sometimes he’s uncovered a history of multiple aneurysms within a family lineage. “The numbers that I was seeing within a single family unit were impressive,” says Stubblefield.
The benefits of military service
Stubblefield had acquired a great deal of medical experience before he entered the PA training program at MEDEX Northwest: 21 years in the military as an independent-duty medical officer, or IDMT. This Air Force program required him to rotate through different specialties, including emergency, dental, surgery, family practice and aerospace medicine. He practiced as an individual provider with the guidance of a physician in remote locations. “You’re doing the medicine, you’re seeing patients, and you don’t have anyone else out there,” says Stubblefield.
He started out in Desert Shield, then Desert Storm. “Yeah, I had a couple of times in the theatre,” he says. Then Stubblefield offered his talents to MEDCAP (the Medical Civic Action Program) at the invitation of host nations such as Vietnam, Cambodia, Laos and New Guinea. These Southeast Asian assignments were part of Congress-mandated POW/MIA missions aimed at recovering the remains of Vietnam-era U.S. veterans. Stubblefield’s job was to provide medical services for local people working with American forensic pathologists on the recovery effort.
“I’ve hit just about every piece of dirt in the world,” says Stubblefield, and these remote medicine experiences served him well in Alaska. The military sent him out to small villages throughout the state, where he provided basic medical and dental services.
As Stubblefield contemplated retirement from the military, his wife and family wanted him to stay in a more populated area. “I’d spent most of my adult life doing remote assignments in other countries, away from my family,” he says. “We were looking at the south central region of Alaska, whether that was in Eagle River, Palmer, or Wasilla. The family was really okay with that.”
The MEDEX Northwest experience
Stubblefield retired from the Air Force in 2009 and decided to apply his valuable medical skills to the civilian population; the MEDEX Northwest physician assistant training program in Anchorage provided that opportunity. In joining MEDEX, Stubblefield followed a time-honored path; MEDEX started, in part, to serve veterans. Today, more than 30 percent of MEDEX’s students come from the ranks of Army medics, Navy corpsmen or Air Force IDMTs.
“That’s what glued me to MEDEX,” says Stubblefield, who remembers the warm welcome faculty gave to veterans at information sessions. He entered school in 2010 and graduated in 2012. “At MEDEX, it felt like I was transitioning from active duty to reserve status,” he says.
While finishing up his second-to-last rotation in Valdez, Alaska, Stubblefield was recruited by the Alaska Native Medical Center. Somewhat to his surprise, he was asked to work as a first assist in neurological surgery. “I’d been in some operating rooms where there was some brain surgery done,” says Stubblefield, “but I was not exposed to neurosurgery per se. I was never trained in it.”
Ash Marquardt, PA-C (Seattle Class 33), the Anchorage site director for MEDEX Northwest, explains. “We recommended him,” says Marquardt.
“It’s true; he didn’t exit MEDEX as a neurological surgical assist PA,” continues Marquardt. “But Jeff has the tenacity to study what he needs to know. I’m sure he went into the job, got an idea of what was expected of him, went home for probably three or four months and just hit the books every night after work until he was tuned up. That’s the kind of guy he is. He may not know everything, but he’ll find out in short order. That’s hugely valuable, and he sets a great example when he’s precepting our students.”
Teaching and guiding principles
In his position at the Alaska Native Medical Center, Stubblefield has precepted a number of PAs and medical students. “I get to expose these students to an inpatient population that’s very grateful for honest care,” he says. They also learn about the community and the difficulties faced by patients. “It has a big impact on them,” he says. “As long as they’re willing and eager to learn, I’m willing to give them an opportunity.”
Stubblefield also teaches as a guest lecturer at MEDEX. “He’s a natural teacher,” says Marquardt. “A lot of this goes back to his military training.” The military emphasizes teaching and training skills so that more than one person knows how to do a job. “Stubblefield can lay it out in steps instead of overwhelming someone with the entire task,” Marquardt says.
Given the challenges of patient care in Alaska, Stubblefield has developed his own guiding principles. “I’ve always been task-oriented,” he explains. “The patient needs something, you do what you have to do to make it happen.” Even if you have bad news, or can’t do what they need, just be honest, he says; you’ll get a pretty good reception.
“It’s not brain surgery,” Stubblefield says.