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

Episode Transcript
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Ashley Love (00:01):
Hello and welcome to Shadow Me Next, a podcast
where I take you into and behindthe scenes of the medical world
to provide you with a deeperunderstanding of the human side
of medicine.
I'm Ashley, a physicianassistant, medical editor,
clinical preceptor and thecreator of Shadow Me Next.
It is my pleasure to introduceyou to incredible members of the

(00:22):
healthcare field and uncovertheir unique stories, the joys
and challenges they face andwhat drives them in their
careers.
It's access you want andstories you need, whether you're
a pre-health student or simplycurious about the healthcare
field.
I invite you to join me as wetake a conversational and
personal look into the lives andminds of leaders in medicine.

(00:44):
I don't want you to miss asingle one of these
conversations, so make sure thatyou subscribe to this podcast,
which will automatically notifyyou when new episodes are
dropped, and follow us onInstagram and Facebook at Shadow
Me Next, where we will reviewhighlights from this
conversation and where I'll giveyou sneak previews of our
upcoming guests.
And where I'll give you sneakpreviews of our upcoming guests.

(01:04):
Today, I'm excited to introduceyou to Eric Fogg, a leader in
healthcare operations,innovation and education.
Eric has dedicated nearly 30years to transforming clinical
services, ensuring that patientsreceive high quality,

(01:28):
accessible care.
As the director of clinicaloperations at his hospital of
employment, he has expandedtheir walk-in services from one
clinic to four, all whilemaintaining an impressive rating
in patient satisfaction.
But Eric's impact doesn't stopat clinical leadership.
He was instrumental inlaunching Maine's first
hospital-based virtual walk-inservice, pioneering the use of
telehealth to expand access toacute care.

(01:49):
He also played a vital role inpandemic response efforts,
overseeing COVID-19 testing andtreatment programs.
Beyond his administrative work,eric is a passionate educator.
Through Pathway to Pass, he hasmentored over 177 students
through their board exams,helping them take the next step

(02:11):
in their medical careers.
In today's conversation, ericshares how a chance interaction
with a PA led him towards the PAprofession at a time when the
field was still growing.
He discusses his unexpectedpath from clinical practice to
hospital leadership and how heanswers the question can a PA do
that?
Time and time again, provingthat PAs can lead service lines,

(02:35):
sit on hospital boards andshape healthcare policy.
He also reflects on theevolution of the profession over
the last three decades from thechallenges of providing
profession over the last threedecades, from the challenges of
providing PA capabilities inhospital systems to the
expansion of roles in emergencymedicine, urgent care and
telehealth.
One of the most powerfulmoments in our discussion is

(02:57):
when Eric describes how he builttrust and credibility in
leadership by letting his workspeak for itself, focusing not
on titles but on delivering highquality patient care and
operational excellence.
Eric's journey is one ofresilience, adaptability and a
deep passion for improvinghealthcare.

(03:19):
Please keep in mind that thecontent of this podcast is
intended for informational andentertainment purposes only and
should not be considered asprofessional medical advice.
The views and opinionsexpressed in this podcast are
those of the host and guests anddo not necessarily reflect the
official policy or position ofany other agency, organization,

(03:39):
employer or company.
This is Shadow Me Next withEric Fogg.
Hey, eric, thank you so muchfor joining us on Shadow Me Next
.
You have this fantastic 29-yearcareer as a PA and it's so
varied and colorful and full ofthings that people might not
realize a PA can do.

(04:01):
Thank you for joining us today.

Erich Fogg (04:02):
Sure sure my pleasure.
Happy to be here.
Thanks for the invite.

Awesome, Awesome.
So let's start.
You've been working as a PA for29 years almost 30 years and I
just want to thank you for yourservice to the field, for your
service to patients and to thePA profession.
I'm sure it has been a reallyinteresting road over 29 years.

Erich Fogg (04:23):
It sure has, and I had no idea where this
profession was going.
Back in the early 1990s, when Iwas exploring what I wanted to
do with my life and certainlylearning about the PA profession
, I was intrigued right, I wasexcited, as a matter of fact,
that the undergrad college thatI went to was getting ready to
start their own PA program.
So in front of my eyes was thisdeveloping new PA program.

(04:46):
So I was further intrigued bythe process.
But fast forward, almost 30years later, I would not have
guessed the journey and thevoyage that this profession has
taken me on.
It's been a blast.

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

Erich Fogg (05:08):
Yeah, great question .
So when I was in high school Iwas an athlete and I found
myself banged up a little bitand spent a lot of time with our
athletic trainer and thensubsequently physical therapist.
That kept me on the basketballcourt and I was really intrigued
by sports medicine.
As a matter of fact, my initialthought was I wanted to be that
physical therapist that gotpeople back on the field, on the

(05:31):
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.
I was a good student in highschool, national Artist Society,
and I was trying to becompetitive to get into graduate
PA school.
So I thought I would take anundergraduate major as pre-med,

(05:54):
like bio right, like most of usdo, and I went to a small
private college in WesternMassachusetts called Springfield
College in SpringfieldMassachusetts, which is known
very famous because it's thebirthplace of the game of
basketball, which was inventedon its campus in 1891.
Yeah, yeah, very cool.
And what was cool about ourmajor was that every quarter or

(06:16):
so they bring in an alliedhealth professional to come talk
to our cohort and our group.
So a physician came in, aphysical therapist came in One
quarter a PA came in who workedat the local trauma center at
the emergency department inSpringfield, massachusetts, and
I was just mesmerized by what hetold me.
He did his role, hisresponsibilities and that was

(06:38):
probably the turning point forme to really start looking at
this.
In the meantime I heard aboutour college starting a PA
program, so we had a front rowseat to watch the development of
that and I was in after that.
And fun little fact, when Iapplied to PA school in 1993,
there was only about 50, 55programs in the country at the

(06:59):
time 55.
Now there's 320 plus programs,so really explosive.
But that was really it justthinking something along.
Healthcare, physical therapybeing just by happenstance
introduced to the profession.
That was starting to gain alittle traction.
But it's not on the US News andWorld Report right as number

(07:19):
one and number two job in 1993.
We were far from that, but thatwas it.
That was the beginning.

What a fantastic experience to be able to listen
to all of those alliedhealthcare professionals speak
and talk about their life.
That's exactly what we're doingwith this podcast is just
getting all of these voicestogether and presenting a day in
the life and the challenges andthe successes and why we love
doing what we do despite thosechallenges.
So what a great thing.
I think that that element ofshadowing and just being able to

(07:52):
pick the brain of somebody whodoes it every day it's so
helpful and it can just directthe entire course of your life.
Like you said, you're justmesmerized by what that PA was
talking about.
Was he also in emergencymedicine, acute care?

Erich Fogg (08:04):
Yeah, for sure, for sure.
Yeah he worked at the traumacenter.
He talked about working,traumas working.
I was like wow, and, to my20-year-old brain, like I just
thought that was just what aphysician did, right, and that
other healthcare professionalswere part of that healthcare
team in that process, that wasjust mind blowing to me.
Right, there was no.

(08:25):
You know, back then I can'tbelieve I'm saying that
expression.
That just makes me feel backthen, right, there was no
internet, there was no, like itwasn't, like I could go home and
Google it, right, or anythinglike that.
It wasn't like I could just puta YouTube video on and review
what this person was.
You had to.
Really you had to go to thelibrary, right, or figure
something out to.

(08:45):
Really you had to go to thelibrary, right or figure
something out, so that was yourway of getting more information
about.
This was different back then.

I'll just say and this is just such a perfect
segue into the fact that youhave been doing this for almost
three decades now.
I'm sure you have noticed majorchanges, and not just
healthcare, but also SPAs aswell, and probably too numerous
really to break down.
But aside from the invention ofthe internet, what is something

(09:08):
that you've just seen PAs do,or seen PAs really develop?
That is just mind boggling toyou.
30 years ago, when you firstjumped on this boat, you never
would have thought that PAswould be involved in this sort
of thing, or perhaps even youwould be involved in this sort
of thing.

Erich Fogg (09:25):
Yeah, I think we all go into this to be healthcare
providers, right that's.
We want to take care ofpatients, right?
That's the most common reasonwe 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 smallcritical access hospital in
rural Georgia.
We were just talking about thatbefore we got started.
And we showed up on our firstday and all of a sudden the med

(09:47):
staff realized that there was nobylaws or no guiding principles
for how we actually couldfunction and work in the
hospital.
We had a contract, we hadstarted and then someone said
wait a second, what are theseguys?
Are they part of the medicalstaff?
What can they do?
What is the whole?
It was crazy so for a week,until they figured it out and

(10:09):
had an emergency meeting withthe medical executive committee
and figure this out, how wecould get there.
It was just a bumpy start, tosay the least.
I thought at one point is thiseven going to work out.
Yeah, to get to the point whereI am in my career now, where I
sit on the board of trustees ofthe hospital right, I am a
non-physician director of 11service lines right, and really

(10:31):
manage a team of providers, thatwas an opportunity that I would
never have envisioned doing 30years ago.
And, yeah, so it's come fullcircle.
I think, to your point, whatPAs can do in the education, the
experience, the knowledge thatwe can bring to a health care
system and be leaders, bedirectors, be innovators right,

(10:53):
be nimble, right and create allsorts of improvements to our
health care system from accessto use of technology to just our
flexibility as providers Ithink has been remarkable and as
more and more people recognizethe value.
When I came to the hospital I'mat now, 18 years ago, I was one
of five non-physician providers.
Right, there was three PAs andtwo nurse practitioners.

(11:15):
Now there's 80.
And to grow that process, wejust stood up an APP council
that I co-chair.
So now we have a seat at themedical exec, we're full voting
members of the med staff.
So all of those things havebeen an evolution, so to speak,
of our profession and wherewe've taken it.

That's great and I'm so glad you mentioned
leadership and education and allof these things, all of these
roles, because you have held alot of these, most of these
roles, and we're going to jumpinto all of it and I just can't
wait.
But tell me, are you stillpracticing clinically, even as
leadership and even as aneducator?
Are you still in clinicalpractice, kind of what

(11:56):
originally brought you to beinga PA?

Erich Fogg (11:58):
Yeah, so it's as of probably a year and a half ago I
had regular shifts.
As my role in demand expandedand our CEO asked me to take on
more projects, my clinicalresponsibilities have dwindled.
Now, every single day I am Irun at least acute care wise, I
run for urgent cares and ourwound center hyperbaric medicine

(12:21):
program.
So every day I'm doing medicaldirection on the phone and I am
really navigating patient care,but not the same as
old-fashioned in the trenchesclinical shifts anymore.
And I'll tell you what.
I incredibly miss it and Idefinitely see myself finding
some time to migrate back tothat.
There's nothing that replacesputting out fires every day and

(12:41):
all day can be challenging initself, but I miss an
old-fashioned shift wherethere's nothing more, I think,
rewarding than direct patientcare.
So, drifted a little bit away,but I have my hands in it.
Every day I manage direction ofpatient care.
I talk through cases with someof my providers.
All of our urgent cares arestaffed by PAs and MPs, so we

(13:02):
don't have any physicians onsite.
So I'm usually the first callthat does triaging, medical
direction, providing guidance,advice and those types of things
.

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

Erich Fogg (13:27):
Yeah, we hire some new grads from time to time,
even mentoring them and gettingthem started.
You remember starting yourfirst job right, Wanting to have
both a little bit ofopportunity to grow your skill
sets and develop, but havingsomebody on a short kind of
phone connection that's hey, canI run something by you type of
thing is or be just stopping inwhen I know that providers and

(13:49):
hanging out with them for anhour or so and reviewing some of
their charts or going over thattype of thing.
So I do a lot of mentoring, Ido a lot of support, onboarding
as well as people start theircareer.

Absolutely.
Oh, that's so cool and I'm soglad you mentioned this.
I spoke with a PA who'scurrently working in urgent care
a couple of weeks ago.
His name's Jim and he has aphysician who signs his notes,
but really the physician existsto him on paper and that's
really it.
When he has concerns, medicalconcerns, when he just wants to
consult somebody, get a secondbrain involved, he calls the PA

(14:22):
the PA who owns the practice andit sounds like it's happening.
But your urgent cares it's allstaffed by NPs and PAs and I
think that is just such a coolthing 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'regoing to consult with and that's
who we're going to pick theirbrain on certain things and
certain patient problems.
But in your case it's a PA,which is fantastic, and a PA

(14:45):
with obviously loads ofexperience.
Are you talking to them a lot?
Is it pretty consistent?

Erich Fogg (14:50):
Would you say yeah, I would say every day.
So on any given day there'seight 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'sgoing on the last few weeks with
Luwe and all the respiratorystuff, there's a lot of volume
and a lot of managing ofpatients, both acutely and

(15:12):
remotely.
So yeah, it's something that wetouch every day.

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

Erich Fogg (15:32):
Yeah, I would say from a clinical leadership
standpoint it was a little bitof a slower burn, I think.
One thing that was, as I lookback on it, I think what really
led to my recognition ofleadership is providing great
patient care.
So when I came to, for example,this organization almost 20

(15:53):
years ago, I was helping tostand up our hyperbaric medicine
and wound care service line andit was a relatively new field
to me.
There's not a lot of PAs thatdo wound care or hyperbaric
medicine and I was brought intoit by an emergency medicine
mentor of mine because of theHBO piece, I think, and some of
its application in emergencymedicine, like carbon monoxide
poisoning or the bends or thosetype of things, I think is the

(16:14):
connection, the attraction.
But I quickly was put in aposition where not only did I
have to learn the new disciplinebut I was also responsible for
being the program director andsetting up this business, so to
speak.
And when you get intoadministrative roles in
healthcare you learn anotherskill set that you're not taught
in PA school and that's how torun a business right.
I was responsible for thebudget and the only budget I

(16:35):
ever ran was me and my wiferunning the household budget
right.
We have a checkbook right.
Bills come in, you pay themright.
You write checks, you keep aledger, right.
That was the extent of it Excelspreadsheets, oh my goodness.
So that was an immersion intothat.
But what it was I think Ashleywas just taking on that
opportunity, right, and havingthis desire and passion to run a

(16:58):
high quality right, highpatient satisfaction, reputable
service line and the other addedpressure to this and I think
your audience will appreciatethat was oh, we have a
non-physician leading a serviceline.
That added another layer.
Can that happen?
Is that possible?
Because that was a relativelynew concept at our small
healthcare system.
It was more traditional in itshistory.

(17:18):
Right, there was always amedical director that was a
physician, right, and so thatpart 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 todetail, hard work, commitment,
attending meetings, puttingmyself out to the medical
community, meeting and greetingright, networking, all that type

(17:39):
of stuff, but most importantly,when that patient that we cared
for went back to their primarycare provider and they had this
tremendous experience and theirwound was healed or their
condition improved.
That helped drive thatreputation of quality and, hey,
maybe this guy knows what he'sdoing.
Then, after getting recognizedin that one small service line,

(17:59):
there was this idea of startingthis network of urgent cares.
Right, those were starting toget popular in the 2000s, early
20 teens, and so Eric, with hisemergency medicine background,
became that person.
I had just put myself in aposition to be recognized to do
that and take that on, because Ihad proven myself in this
smaller kind of hey, let's say,eric tried this and we started

(18:21):
with one, and then two, thenthree, then four, and it just
built from there and I justopportunity begets opportunity.
That's the message that I wouldgive you and your listeners is
don't be afraid to put yourselfout there, Take a chance, but
just do a great job.
Right, it sounds so simple andit's not simple, but do a really

(18:41):
good job, just like anythingelse in life.
Right, if you do a really goodjob, people tend to notice.
So that was it, and then itgrew from there.
Then I was asked to be thefirst PA ever on our hospital
board of trustees as well, or totake on some other committee
work that was important to theorganization, like this new APP
council.
It seems like there's momentumthat builds once you start

(19:02):
adding successes to your docket.

You mentioned a couple of times.
Now you've said the questionhas been presented to you Can a
PA do that?
Can a PA do this?
Can a non-physician person bethis person in this role?
And you have answered thatquestion.
Yes, it sounds like so manytimes.
And then you also have to backthat up right.
You have to prove it, you haveto do a good job and when that

(19:29):
happens, it does sound likeyou're rewarded.
Did you ever feel like youfaced a lot of controversy or a
lot of pushback?
And if you did, how did you putyour head down and just kind of
power through and continuouslyshow up every single time?

Erich Fogg (19:45):
Yeah, I think most well a lot of your listeners
might relate to if you work in acommunity or a culture.
There's and it's much betternow than it was, I think, 20
years ago that there might besome people who are less
supportive to this role, right,and maybe don't have a seat at
the table.
That's their history or theirbackground or their reputation,

(20:11):
reputation.
So it was always a littlechallenging when I needed to
make a call to a physician whomay or may not have appreciated
that I was not Eric Fogg theperson, but that a PA was caring
for their patient in aspecialty practice, so to speak.
And I think early in my careerI might have got a little bump
on that type of thing, but Ididn't let that deter me because
I let the work speak for itself, right.
Challenge me If you think youknow, if you have feedback for

(20:34):
me or if you think we could havedone something different or
something better.
I welcome that feedback and Ijust I put myself out there in
the work that I did to speak foritself, right, and I tried to
get away from titles or lettersor credentials after my name and
just let the quality of thework that we did speak for
itself and it got to the pointI'll never forget.

(20:55):
The last frontier at ourhospital was putting PAs in our
emergency department.
It had been a traditionalphysician-based department and
one of the nicest compliments Igot was I'm not sure we're ready
yet for this integration, butwe'll let Eric break the ground
on this right.
So that kind of was thatrecognition that I had reached a
point in this organization,that there was trust.
I had built trust and then onceI started doing some shifts in

(21:18):
demonstrating what the role of aPA could be in that department
that was eight, nine years ago.
Whatever that department has PAcoverage seven days a week now
and it's just integrated as partof 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 inthat mindset then you're always
in this defensive posture allthe time.
I looked at more as anopportunity.

(21:39):
Let me prove to you.
Let me prove it to you.

I think that's great.
You're right, it's all about amindset, absolutely, and you do
it so confidently and I think itprobably comes from a lot of
practice.
Do you ever feel nervous aboutwhenever you're asked to start
these new initiatives or developthese programs, anything?
Are the nerves still there ordo you just rely on the fact
that you've done this time andtime again and with practice and

(22:06):
with seeing a history ofsuccess, it just becomes a
little bit more comfortable?

Erich Fogg (22:12):
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 therewas a new opportunity.
I'll give you an example.
I've done medical malpracticework for almost 20 years, right?
I've been deposed 36 times,I've been to trial nine times, I
reviewed over 50 cases and Ihad a trialosed 36 times.
I've been to trial nine times.
I reviewed over 50 cases and Ihad a trial testimony last week.

(22:34):
And no matter doing it for 20years as I got ready to go under
oath, eric, will you raise yourright hand?
You swear to talk truth, right?
I just, you know, got that.
I don't care how many timesyou've done it If you're not
human, if you don't get a littlebit anxious about those.
But anxiety is often I look atit as a motivator right, anxiety

(23:00):
or being anxious allows you tobe more focused, to be more
driven.
You can.
Anxiety can be paralyzing.
I work with maybe we'll talkabout this I work with students
who are remediating their boardexams or struggling with their
high stake exams during PAschool and one of the things
that challenges students oftenis that performance anxiety or
test-taking anxiety.
I've developed techniques andstrategies to help me navigate

(23:21):
when I get anxious, whetherthat's breath work,
visualization, positiveself-talk or just thinking back
to the successes I've had asthings 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 littlenervous, right, I get a little

(23:42):
nervous.

It's nice to hear.
It's nice to hear that, eventhough you are so practiced and
so successful, the nerves arestill there, but they do.
They sharpen us An.
Even though you are sopracticed and so successful, the
nerves are still there, butthey do.
They sharpen us Anxiety.
I do think it can sharpen us aslong as we use it as a tool and
not let it overwhelm us.
Let's talk about Pathway toPass, because you've already
mentioned it and I think it'sjust such a cool thing that you
offer.
You have helped over 130, Ibelieve it is students succeed

(24:05):
on their board exams, which ishuge.

Erich Fogg (24:17):
Thank you for that and what you're doing with these
students, what interested?

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

Erich Fogg (24:20):
I've been on a roll here in the last couple of
months, but I'll tell you thestory really quick and remember
I had an educational background.
Back in the early 2000s, me andsome friends started a CME
company.
We traveled all over thecountry and taught so education,
I was involved in PA education.
I was a former program director, all that.
So I have this educationalbackground.
But I also had some experience.
I was trained by the NationalBoard of Medical Examiner to

(24:40):
write high-stake exams and foryears I wrote high.
Back in the day there weren'tQBanks like there exists now
that students can use to preparefor exams, exists now that
students can use to prepare forexams.
Faculty wrote their ownquestions.
I did some work with the NCCPAand got involved with that
organization.
So I had this backgroundregarding psychometrics of exams
and test taking and being aneducator and all this.
But here's the story and you'regoing to love this story.

(25:03):
About five years ago I wasworking a clinical urgent care
shift and the rad tech came intomy little dictation room and
said Eric, a woman called herelooking for you.
Here's her phone number.
You were seeing a patient andshe hands me this piece of paper
and it has the name on it thatI recognized as a colleague from
maybe 20 years ago.
Right, I thought to myself, isthis a patient or no?

(25:25):
It didn't sound like a patient,eric.
But she said to give her a callback and this colleague was the
former program director at Yaleand she was very involved in PA
education and helped start theprogram in Boston, and so I knew
the name and it had aConnecticut area code on it.
So I thought to myself this hasto be, this has to be Mary, my
old colleague who went to Emorya couple of years before me.
I'd just known her most of mycareer, so I called her up and I

(25:47):
said first of all, mary, goodmy career.
So I called her up and I saidfirst of all, mary, good to hear
your voice, how's the family?
It's been years Like, how areyou Good, how are you, how's
your family?
She says I'm sorry to botheryou, but I thought of you
recently because I have a familyfriend whose daughter just
failed the pants.
And I said oh, mary, I'm sosorry to hear that, but why are
you calling me Like?
She said Eric, I was racking mybrain, like how can I help my

(26:09):
family friend and she says youknow my background, but I don't
have the expertise you do Likeyou're like.
I thought of Eric Fogg and Ihave to.
She said I Googled you.
I haven't talked to you inyears.
I found out on Google where youworked no-transcript.

(26:57):
She was embarrassed, she wasupset, disappointed, she was
heartbroken, right, but she washungry to fix it.
She was hungry to fix it.
So my next question was, becauseI know the background of this
exam pretty well, I said whatwas your score?
And she said, eric, I got a 239.
So for all the listeners outthere, or I don't know if you
remember your pants 350 is thecut score.
So 239, not good, not good Off.

(27:20):
Lots of work, big mountain toclimb.
So I thought to myself I lostall the color in my face.
Now I'm being set up.
I have Mary who has this highexpectation of me, and I have
111 points to make up.
So what I did?
Really quickly I'm making thisstory all too long, but this was
during COVID, so we weremeeting just like this on Zoom.
So I threw up like a questionon it, shared it on my screen

(27:42):
and I said Maria, walk methrough this question.
And I could immediately tellshe was smart and bright, which
anyone who gets into PA school.
Like smart, high admissionscriteria, very difficult
curriculum to get through, it'shard, right.
So if you graduated from PAschool, you have a foundation of
knowledge that I would assumeis solid, right.

(28:03):
But I could tell she was smart,she was bright immediately.
But as we started doingquestions, I recognized that she
had these inconsistenttest-taking errors overthinking
questions, changing answers,narrowing it down to two,
picking the wrong one, missingclues, not understanding what
the clues were.
Just didn't have a good processand she would what I say, leave
points on the table by gettingquestions wrong where, if I
talked to her about the content,she knew the content.

(28:25):
So this light bulb goes off.
Like all these years of writingtest questions and all this
experience and training, I'mlooking at the world through the
lens of a test writer and Irealized she's looking at the
world through the lens of a testtaker.
And if I just show her my lens,like, why do you think the
author picked a 17-year-oldfemale?
Why is that important, eric?
I've never thought about thatway.
What do you mean?
You've not thought about it.

(28:45):
That's the the whole point ofthe question.
It's like this light bulb goesoff, and so to make a really
long, this is even gettinglonger.
I work with her once a week foreight weeks, so eight hours.
She needs 111 points.
Now, as the test approaches, Iam not optimistic that I can
make that jump just in oneattempt.
I think maybe I have to stagethis, maybe a jump and then a
jump again, maybe three times.
I knew she was going to dobetter, but I had no expectation

(29:08):
and I'd never done this beforeshe 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, sothe program that she attends
calls me a week later.

(29:35):
Eric Fogg, we've been directorhere of the program for 12 years
.
We've never had a studentimprove 160 points.
Who are you?
Who are you?
Hey, by the way, we haveanother 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 manyprograms with second year
students who are identified asat risk, who are struggling with
EORs and that type of thing,and it's just turned into
something that I never.
It was a phone call when I wasworking a clinical shift from an

(29:57):
old colleague who had a friendwhose daughter failed the pants.
And here I am, this.
It's amazing.
My day actually startedyesterday from.
I got a text message at 7.17 inthe morning from a student who
I helped last year who hadfailed it four times before she
had got to me.
She had graduated in 2022, hadreached out to me in 2024 after

(30:18):
four failures.
I worked with her for threemonths.
She passed the exam this pastfall, got her dream job, and I
hadn't heard from her in a fewmonths and I wake up to a text
that says Eric, I just want youto know.
I'm sipping my coffee gettingready to head out to my first
day of the PAC and I want to saythank you.

Wow, I have chill bumps.
That's amazing.
How good does that feel?
That has just got to beincredible, and I just need to
say it because I feel like evensomebody who does not pass their
test four times is going to bean incredible PA.
It's a standardized test.

(30:56):
It's like you said there'stechnique and strategy and you
know the material, but you haveto know how to apply the
material.
And good for her.
I hope she has enjoyed herfirst day.

Erich Fogg (31:09):
Yes, and this afternoon a student who I helped
pass said Eric, I just got mydream job, a PA oncologist at St
Jude Hospital in MemphisAmazing, and I wouldn't be here
without you like this.
And I don't know if that'snecessarily true, but these are
bright, talented people thatmaybe just needed a little bit
of direction or whatnot, but ithas become a passion project and

(31:31):
talk about all the things thatyou want to even talk about
tonight.
This is by far one of the mostfun and rewarding things.
These people are vulnerablewith me.
These people come to me whenthey're down and out, and to
just hear their story, to givethem hope, to give them
inspiration, to give themconfidence, has been just
incredible.
Patient care is great, helpingpeople get better and all that.

(31:53):
That's rewarding, but this isits own thing and it's been
great.

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

Erich Fogg (32:13):
They're trying to take their boards and they just
can't pass that god awful test.
And you've taken it at least ahandful of times.
At this point I'm up.
This year I went for my Pan Raythis year, so we'll try it
again.

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

Erich Fogg (32:22):
See, I'm a one day guy, let's go.
I'm not like cause I'm a reallygood test taker and I'm an
expert test rep To me.
Let's go, do it, you'reprobably excited about it.
I put a few hours in, right,I'm ready to go.
I love that, but I like thatthe NCCPAs create different
pathways for people.
Meet them where they are rightIn terms of whatnot.
Yeah, that's a great tool forthose who self-pace busy that

(32:45):
type of thing.
I just don't love standardizedtests.
There's a lot of people thatjust Absolutely, absolutely.

When we recertify as PAs, we recertify every Now
it's every 10 years and there'stwo options.
Like you were talking about,you can go in, sit at a testing
center with you and the computerin your brain, take the test
and that's it.
It's a one-day, one-time thing.
Or the other option, like Ijust finished and passed, is the
Panray LA longitudinalassessment and that is where you

(33:16):
have X number of questions, aquarter over an extensive amount
of time so I think it was twoyears for me.
It can be up to three years andyou get to do that at home at
your computer and there arebenefits to both.
And it's so funny becausepeople are very black or white
on this issue.
Either they're like you andyou'll say no, absolutely not
One time I'm done, I'm justgoing to take it and pass and be

(33:36):
confident.
Or they're like me, where I'mlike I cannot fathom a life
where I would actually go andsit down and take that test
again in a testing center.
So it has been a reallyinteresting addition, I think,
to the PA profession and a niceway to, like you said, meet
people where they are and wherethey're most comfortable.
So that's been really fun.
Now, before we step away fromyour career in education, which

(33:59):
is just so much more in-depththan we already talked about, we
have a segment on the showcalled Quality Questions.
It's something that is our giftto you and to help you really
just discover some interviewquestions and things that you
might not have heard or youmight not have considered.
So, eric, do you have a qualityquestion for us?
Before we hear what Eric'squality question is, keep in

(34:20):
mind that there's more interviewprep, such as mock interviews
and personal statement review,over on shadowmenexcom.
There you'll find amazingresources to help you as you
prepare to answer your ownquality questions.

Erich Fogg (34:33):
Yeah, and listen.
I think one of the really hottopics in our profession over
the last probably going backdecades has always been the name
physician assistant, right?
Is it the right name, right?
What does the word assistantmean and what's the connotation
of that thing?
Does it make patients moreconfused?
Does it best represent the roleand responsibility that we do?

(34:56):
I think most people would agreeit probably wasn't the best
name, but over time, this hasbeen a topic that had been
approached.
So one of my quality questionswould be what are your thoughts
on the change in the name fromphysician assistant to physician
associate?
This was something that wasvoted on through our legislative
body in the AAPA back in Ithink 2020-ish.
I think 21, 20, can't rememberthe exact, but it's within the

(35:18):
last five years and that hasbeen a long time coming.
This has come up multiple timesover the years, and so I think
the quality question is do youthink the name change from
physician assistant to physicianassociate will be a benefit,
right?

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

Erich Fogg (35:57):
So I live in Maine and this was something that I
learned.
So I'm from New England, fromMassachusetts, originally, but
spent time in the South and wentto Emory and my first job was
in rural Georgia and very.
Something about the South Ialways love was some of the
formality of South.
As a matter of fact, what Iloved was when little kids even
addressed you as an adult it wasalways Mr Eric right, it was Mr
, but your first name.
I always thought that was super, super cool and stuff.

(36:17):
But I was.
It just seemed like the culturewas you addressed.
Even my supervising physician,who I thought was my friend, I
always, out of courtesy wouldsay, or out of respect, say oh,
dr Jones or Dr, whatever right.
So in living in Maine orNorthern New England there's a
little bit less formality to it.
So I actually, when I go into aroom to see a patient I said,
hey, I'm Eric, the PA workingtoday.

(36:37):
I'm here to take care of you.
How can I help you?
So I would say my first nameand I always refer to myself as
a PA.
I have a badge that saysphysician assistant on it, very
visible to everyone, my pictureon it, that type of thing.

So I'm properly identified that sort of thing,
but I was going to introducemyself by my first name and the
credential PA.
Yeah, no, that's exactly what Iteach you.
And there was one PA that Irotated with.
He was in urgent care inPalatka, florida and he would
say hello, I'm so-and-sophysician assistant.
And he's the only person that Iknow that literally every
patient spoke it in full forthat patient.

(37:17):
And now, granted, this was inPalatka Florida, which is very
rural, and perhaps not many ofthem knew what a PA was.
So it makes a lot of sense, butbut no, the formality is.
It is very interesting.
That's exactly how I introducedmyself to you.
I'm Ashley, I'm one of the PAshere and I'm proud of that, you
know, and I think that nowadayspeople do recognize PA, whether

(37:37):
they recognize physicianassistant or physician associate
.
It will be, time will tell,we'll find out, for sure, for
sure, very good.
Thank you for that qualityquestion.
That was great, eric.
Let's can we talk a little bitabout innovation, because
innovation is such a big wordand I think there's a lot of
excitement around innovation andyou have such a fantastic

(37:58):
history with what innovationlooks like.
As a PA, you have launchedMaine's first hospital-based
virtual walk-in service.
You developed a COVID-19testing and therapeutic program
virtual walk-in service.
You developed a COVID-19testing and therapeutic program.

Erich Fogg (38:18):
What does innovation mean to you as a PA and why is
it so important?
Why are we even talking aboutit?
The world is changing quickly,right, very quickly, and our
ability to navigate complexsystems can often be better, be
made easier, by innovation, andwe'll use the virtual, like
telehealth has become, andcertainly COVID really rapidly
accelerated the adoption oftelehealth, but it's been around

(38:38):
for a long time, a really longtime, probably longer than
people think.
And if you're from the WestCoast listening to this, the
whole notion of telehealthvisits really started in the
2000s, probably on the WestCoast.
But I saw an opportunity at ourcommunity hospital that we
could offer convenience andaccess by.
I noticed, working in our urgentcares, that we saw a lot of

(38:58):
relatively low acuity, simpletype things from poison ivy to
really benign presentations that, although required management
and care, didn't really requireyou to get out of your living
room and drive across town andcome and wait in line or sit in
this waiting room with sickpeople or whatever.
And I had colleagues and friendsall over the country that were

(39:20):
starting to dabble into this andNew England was relatively slow
on this curve.
So I thought I had this, I hadtaken a leadership course that
was run through the state forhealthcare providers and you had
to do like a project, so aspart of this leadership course.
So my project was to beintroducing this telehealth
urgent care program in ourcommunity.

(39:41):
Just to dip our toe in thewater, and in 2014, when I
thought about this, there wasn'tthese EMRs that had telehealth
software embedded in it, so Ihad to go out to the market and
try to find a HIPAA compliant.
Remember Skype?
Remember it was a connectivetool before Zoom and all that
Like Skype just wasn't going tocut it, if you knew what I mean
right.

(40:01):
So you had to find a HIPAAcompliant.
I found a little startup inSalt Lake City and we partnered
with them.
They were relatively low costbecause they were new and we had
a small project and I had toput together a training program
for our providers that's.
I think you'll find this cute.
We're always taught bedsidemanner when we go to graduate
school.
I had to teach website manner.
Oh, I like it.
Yeah, just because you and Iare talking now I could look at

(40:23):
the camera and it looks like I'mlooking at you If I look at the
screen, like there's how youaddress people on video, zoom
chats or whether I came up withprotocols 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 smallcommunity.
I even convinced we have afleet of cars at our hospital
that take people to appointmentsand that type of stuff.

(40:44):
It's cool.
It's a little bit of athrowback, but I convinced my
pharmacy group and ourtransportation services that if
you live within five miles ofthe hospital, I'd even run your
script out to your house, rightas a trial kind of thing to see
how it goes.
And, ashley, you know whathappened.
We put all this work in it andno one really came in.
No one really, I mean loggedonline, no one.

(41:05):
And we tried to market it alittle bit.
We tried to, so this wasprobably 2017.
We started to go live with itand we'd get a little trickle
here and there and it just waslike I'm like what is wrong with
it?
I thought people would lovethis, people would love this.
So, finally, I'm working a dayand I see a gentleman who I see
every year, who comes in withwhatever complaint and it was a
perfect complaint for atelehealth visit and I said, hey

(41:28):
, we got you all squared awaytoday, but let me walk with me.
Let me show you this littleroom that we've built and the
computers in here.
And wouldn't it be cool if youjust sat at home and you
connected with me like you doFaceTime or anything like that,
and I evaluated you and we ranthe 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

(41:49):
with the technology andeverything.
But you know what?
Your waiting room is so nice.
You have coffee in here, yourstaff is really nice.
I just like getting out of thehouse and coming in here and I'm
like, oh gosh, maybe we weren'tready for this.
But then COVID hit and becauseI had this stood up and when
everything shut down within ananosecond, I flipped it and we

(42:11):
were all trained and we were allready.
So, by happenstance, it turnedout to be a reallyosecond.
I flipped it and we were alltrained and we were all right.
So, by happenstance, it turnedout to be a really great thing.
But I thought I failed.
I thought I failed with thisproject and then the world
changed and to this day, I keepit stood up.
It's an option.

It's interesting because it's two situations here
that I'm thinking of.
Going back to Maria, who isyour first student, that you
that you helped pass her boardexams.
In that case student that youhelped pass her board exams In
that case, need was what builtthe innovation right.
There was a need and you had anidea and you solved that and
then you built this incredibleprogram.

(42:44):
In this case, the innovationcame first and then the need was
realized.
I think so many times we havethese ideas and we really don't
elaborate on them because itdoesn't seem like there's a
place for it or a need for it ora person that it could benefit.
But if it's a great idea, likeyou said, put in the work, put
in the effort, throw it againstthe wall a couple of times, see
if it sticks Because hopefullywe don't have another global

(43:06):
pandemic, but maybe your globalpandemic is just a couple of
years away and then it becomesthis fantastic, ready-made
solution, innovative solution tothe problems.
Do you see anything coming downthe pipeline with what's next
with innovation?
We mentioned telehealth, ofcourse, like AI is such a big
thing right now and I don'tthink that PAs or really any

(43:28):
healthcare professional is goingto be overtaken by a robot.
But what do you see, whatexcites you about innovation in
PA, in the PA world, or maybeeven just medicine in general
right now?

Erich Fogg (43:38):
I think to speak to medicine in general.
I got an Oura ring forChristmas.

Fantastic.

Erich Fogg (43:44):
Wearables.
I have the Apple watch.
We all have an Apple watchAdding.
I think the wearable technologyis going to be game changing in
the field of medicine and Ithink there's a lot of
information that can beextracted as this technology
even improves.
So the Apple Watch is great andthere's a lot of things it can
do and they continue to, I think, innovate there and even can
diagnose arrhythmias and allthat type of stuff.

(44:06):
What I find super cool aboutthis Oura Ring is the sleep data
right and the sleep points andall that type of stuff.
I think, as we continue toevolve this type of technology,
we can be more proactive inpreventative medicine right.
Our system is phenomenal atreactive medicine right,
treating conditions right.
Wouldn't it be great if we justhelp people not get sick right?

(44:30):
Or chronic disease managementand that type of thing?
So I see that really issomething that's accelerating.
It seems like that's catching alot of momentum.
Ai is super interesting, as Ithink that will be part of.
I think even things like evendoing.
We've dabbled with scribingusing AI and technology where
there's still this exists, whereyou could bring a scribe in the

(44:52):
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 inand that sort of thing.
You get on Zoom meetings nowall the time and there's an AI
note taker right, capturing thenotes and all that.
So I think what we arechallenged with correct me if
I'm wrong, I think you'll agreeis the paperwork and all these
challenges of documenting andall that sort of stuff.

(45:13):
And we're feeling as healthcareproviders.
Sometimes we get disconnectedfrom the patient care because
we're looking at a screen allthe time.
Right, can even advances ininnovation improve that part of
our life and allow us to betterfocus on patient care?
Right?
Can we use wearable technologyto predict when patients might
be getting sick or might bestarting to have exacerbation of

(45:35):
their heart failure or otherchronic medical conditions?
So I see that as the area inmedicine.
I think PAs have positionedthemselves as leaders now we
talked about in leadershipposition to help bring those
changes to fruition in yourpractices, in your systems,
those types of things.
So I think we have a role inthat will be really important

(45:58):
going forward.

I agree.
Those are two really excellentexamples, and thank you for
talking about wearabletechnologies as a good tool, not
just one that spies on us andtattles on us to our providers,
because that's not what it does.
Sure, eric, thank you so muchfor joining us today.
In closing, you have had somany incredible experiences as a
PA in healthcare and you haveworked with so many, I'm sure,

(46:21):
incredible healthcare providersas well.
You've also trained a lot ofstudents and have worked in
education for a really long time.
So, with all of that, in youropinion, what qualities do you
believe make a fantastichealthcare provider?

Erich Fogg (46:37):
Yeah, wow, that's a really great question.
I have changed a lot as aprovider as I've grown in this
profession and I'm alwaysreminded of when we see patients
.
It's often at their worst orone of their worst days, right,
and I'm often humbled by thatprocess that what an opportunity

(46:59):
, what a gift it is to take careof someone when they're coming
in to see you when they're attheir worst.
So it always grounds me in thatprocess of remembering our role
in this whole system of healthcare, right, as health
healthcare providers.
And I think it's listening, Ithink it's empathizing, I think
it's validating what they'resaying.

(47:19):
Sit down in the room when youtake a history, right, don't
stand up and look down at yourpatient, right, sit down, get
eye level, make eye contactright, maybe put a hand on their
knee or something like that.
That they're listening.
And I do a lot of coaching andcounseling to our providers and
new grads.
We have things like Press Ganeyand we could talk about that

(47:40):
for hours, right, patientsatisfaction scores and that
type of thing.
But really it's not to me aboutthe Press Ganey scores as much
as it is when patients write inthese narratives about their
experience on our service linethat I'm most proud of and I
send that to our CEO and I sendthat to our community.
Yeah, you come into our serviceline and this is the experience

(48:01):
you get and to me it's justabout being genuine, it's being
caring, it's being nice, right?
I always say when I hire staff,I can train you.
I've been doing this longenough.
I can teach you to read a chestx-ray and EKG, I can teach you
the suture, but I can't teachyou to be a nice person.
So I hire good people and I cantrain the skill I might have,

(48:22):
the most talented, skilledperson, but if the other pieces
aren't there, I found it's notalways the best hire.
So be a good person.
How about that?

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

(48:55):
Shadow Me Next.
I cannot tell you how thankfulI am for everything that you
have done as a PA for ourprofession.

Erich Fogg (49:02):
What a great platform you have and
congratulations to you for yoursuccess with this and keep doing
that.
Great Proud to be here, thankyou.

Thank you so very much for listening to this
episode of Shadow Me Next.
If you liked this episode or ifyou think it could be useful
for a friend, please subscribeand invite them to join us next
Monday, as always.
If you have any questions, letme know on Facebook or Instagram
Access.
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15 - A Veteran Physician Assistant's Views on Medicine: Past, Present, and Future | Erich Fogg, PA-C

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.css-14f5ked{margin:0;word-break:break-word;display:-webkit-box;-webkit-box-orient:vertical;box-orient:vertical;-webkit-line-clamp:2;overflow:hidden;}15 - A Veteran Physician Assistant's Views on Medicine: Past, Present, and Future | Erich Fogg, PA-C