An Interview with Brad Biskup, PA-C
Co-Chair, ACLM's PA Working Group
We had the opportunity to sit down with Physician Assistant Brad Biskup, co-chair of ACLM’s PA Working Group, for a Q&A session. Brad is a glowing example of the integral role physician extenders play in advancing lifestyle medicine, making it a clinical practice profit center, while transforming patient lives.
Q: What’s your educational background, and what have been the major milestones in your clinical practice journey?
A: I have to go way back to being born and raised on a farm in Nebraska. I wasn’t exposed to many different professions other than farming and teaching. Even so, I decided early on that farming was not for me, leading to my college majors in engineering, animal science and then exercise physiology. I found my passion working with patients in cardiac rehabilitation. I received my BS in Exercise Physiology at the University of Wyoming and completed my Exercise Specialist Certification through the American College of Sports Medicine
My first job after college was as a research assistant in osteoporosis and exercise at the University of Connecticut Health Center. I also worked intermittently in cardiac rehab before going to PA school at Quinnipiac University in Hamden, CT. This experience allowed me to have a greater impact on the health of patients. I have taken additional courses through the National Lipid Association and am certified in tobacco dependence.
Q: What first sparked your interest in Lifestyle Medicine?
A: My primary interest in Lifestyle Medicine was from understanding the benefits of exercise, and subsequently the nutrition component, as well. My background helped me significantly when I started seeing patients in cardiology.
The cardiologists I work with are unable to spend time with their patients discussing diet and exercise, even though these physicians understand just how important these factors are to disease prevention and treatment. As one of our interventional cardiologist said to me, “You have found the niche that no one else focuses on.”
Q: I understand that you established a Lifestyle Medicine clinic within the University of Connecticut Health/Cardiology Department long before your association with the American College of Lifestyle Medicine; explain the impetus for creating the department and the impact it has had?
A: I was fortunate to start working in cardiology at the UCONN Health Center, seeing patients as well as doing stress testing. This is when my focus on patients’ lifestyle began to truly evolve. Since most patients in cardiology have significant primary or secondary risk factors, I was able to focus on their cardiovascular risk factors—such as high cholesterol and diabetes—using both medication and lifestyle to reach their goals.
After a few years of tremendous results by treating patients with a focus on lifestyle changes, we started the Lifestyle Medicine Clinic through the Calhoun Cardiology Center at UCONN Health; this included our Lifestyle Medicine Lecture Series.
The Lifestyle Medicine Lecture Series has grown from three to four attendees per lecture to 125-150 people per lecture! The lecture series has helped me to continually educate myself and our patients—as well as my fellow colleagues—about choices that can be made other than medication.
Our lecture series topics over the last year have included: 1) Clean Eating, 2) Stress and Lifestyle, 3) Controlling Your Cholesterol without Medication, 4) Diabetes and Lifestyle Medicine, 5) Exercise Can Be Medicine, as well as, 6) Cancer and Lifestyle Medicine.
Education is key. I feel strongly that the outstanding results we are seeing are due, in large part, to our focus on educating patients and health care providers about the benefits of Lifestyle Medicine. As the leaders in the American College of Lifestyle Medicine continue to say, “We have the science, now we just need to implement it.” This starts with sharing the science, whenever possible.
Q: Is the Lifestyle Medicine clinic a revenue center for the cardiology group practice; and, if so, how have you structured it so that it is?
A: I see cardiac patients, as well as patients with significant cardiovascular risk factors, and it has been very successful. Being a physician assistant, I work closely with a cardiologist on the initial patient consultation and then individually for follow-up visits. Shared medical appointments have been a core piece of the equation, where I have the opportunity to educate groups of patients—leveraging the time spent. I also have what I call ‘walking appointments,’ where my patient and I take a walk during our visit, reinforcing the importance of incorporating movement into your daily routine.
Q: You’re an active member in ACLM. What led to you establishing the PA (physician assistant) Working Group, and what do you hope to accomplish?
A: In the summer of 2015, after having joined ACLM in 2014, I saw that there wasn’t an organization for PA’s within the college. I emailed our president, Dr. David Katz, who put me in contact with ACLM’s Executive Director, Susan Benigas, and Dr. Ingrid Edshtyn, both of whom helped me to start organizing PA’s within ACLM. With the help of Jennifer Drost, PA-C, we co-chaired the start of the PA Working Group and now have weekly conference calls between the co-chairs and monthly conference calls for all PA’s in ACLM so they can be active in developing PA’s in ACLM.
My vision for the PA Working Group is that we do what PAs do best, work as a team. This has started with sharing presentation on Dropbox, as well as networking around the nation and learning from each other’s experiences. Also, since the curriculum from my PA education didn’t include Lifestyle Medicine, my goal is to have Lifestyle Medicine become part of the curriculum in PA schools throughout the country.
I would also like to develop a certification for PA’s in Lifestyle Medicine through ACLM. The American College of Preventive Medicine and ACLM have just launched a Lifestyle Medicine Core Competencies online course, which will be ideal for both physicians and PA’s—and our NP and RN counterparts. We should be held to the same standards as physicians. The certification will give credibility to PA’s in Lifestyle Medicine. When a PA is certified in Lifestyle Medicine through ACLM, a physician or group should feel assured about their Lifestyle Medicine education.
Q: Why are physician extenders (physician assistants and nurse practitioners) such an important component of a Lifestyle Medicine practice—especially in light of the shift to a value and outcome based model of healthcare delivery?
A: I believe that physician extenders are a perfect fit for a Lifestyle Medicine practice, especially with the new changes in healthcare towards a value and outcome based model. The current way we provide healthcare is “disease management” and has been shown to be extremely ineffective financially. Currently, most healthcare providers tell their patients, “You need to exercise and lose weight,” but they don’t take the time to delve into the emotional aspects of behavior or give them the tools to help their patients be successful. As a result, the disease manifests itself, and then the primary way to treat the disease is with medication. This is where the physician extenders have a wonderful opportunity to fill the void with Lifestyle Medicine.
Most physician extenders in Lifestyle Medicine are great at giving patients the tools to be successful, which starts with educating their patients. An example, when I have a patient who is a borderline insulin-resistant diabetic, I educate them by showing them powerpoint slides on the cause of insulin-resistance being due to a high glycemic diet and inactivity. After understanding the cause, we develop a plan that starts from their current lifestyle, making little changes by moving more, eating more healthfully, and better managing stress. The most rewarding time is after three to four months, when the follow-up lab work shows significant improvements as a direct result of these lifestyle changes.
The medical background we have as healthcare providers, the cost effectiveness for physician extenders, and the ability to relate well with patients is why, in the evolving healthcare delivery system, physician extenders will be highly valued.
Q: What message do you have for your medical professional colleagues about the American College of Lifestyle Medicine and the field of Lifestyle Medicine in regard to the impact it can have on health and healthcare?
A: As I care for my patients, I know that spending time on Lifestyle Medicine is the right thing to do.
I saw a patient this week I’ve been working with for a few months. Just prior to starting in the Lifestyle Medicine Clinic, his hemoglobin A1C was 7.1 and his liver enzymes have been elevated for over 13 years. He came to the Lifestyle Medicine Clinic after seeing my Lifestyle Medicine Lecture on “Diabetes and Lifestyle Medicine” saying that he didn’t want to take medication for his diabetes. We discussed the cause of his diabetes and what he could do about it. After four months, we rechecked his lab work, and I told him I had bad news. His hemoglobin A1C was 5.2 and his liver enzymes were completely normal. I asked him what medications he was taking for his diabetes. He said, “None!” I said, “That’s right! All of these changes in your labs are from your lifestyle changes, not prescription medications!” He asked what the bad news was. I told him I can’t take care of patients who have better labs than I do (with a smile).
This patient is one of many successes of Lifestyle Medicine. I can’t think of many things more gratifying than to give patients the tools, the support, the motivation, and the care they need to be successful in treating the cause of illness and watching them be successful. I remind them that the medicine they are taking is “Lifestyle Medicine.”
In 2014, about four years after I had developed the Lifestyle Medicine Clinic at UCONN, I was reaching out to try to find other people who practice Lifestyle Medicine. I was active in the American College of Cardiology, but, at ACC, the primary focus isn’t on treating the cause. I knew there had to be an organization that focused on lifestyle medicine, so I started searching the internet and found the American College of Lifestyle Medicine. It was a perfect fit! ACLM had significant credibility since the pioneers in Lifestyle Medicine were members or were lecturing at the annual ACLM conference. I went to the 2014 annual ACLM conference in San Diego and saw that the way I was practicing Lifestyle Medicine was very similar to what was being recommended. I thought there needed to be a greater focus on exercise, which motivated me to submit a presentation for Lifestyle Medicine 2016 on Exercise within Lifestyle Medicine; I’m excited to say that I will be presenting at the annual ACLM conference in Naples, Florida this October. This shows how we all can have an impact on what ACLM is.
ACLM isn’t just a few people who work in Lifestyle Medicine. It is the passion and vision of everyone in Lifestyle Medicine who want to provide “healthcare” by treating the cause and giving our patients the tools to be successful. This isn’t about our ego on who is the best. As one of the visitors to the ACLM booth at the American College of Cardiology conference in Chicago a couple months ago said, “Everyone else here is selling something, such as medications or equipment, what are you selling?” Susan Benigas, ACLM’s executive director, proudly said, “Nothing other than health, hope and healing.”
ACLM is the vital go-to resource where we can learn from each other, help each other become better Lifestyle Medicine providers, and share the research of Lifestyle Medicine to “treat the cause,“ so we no longer have to be “disease management” providers.