A Different Breed of Provider

Somewhere in a deployed environment, a Soldier is wounded. A combat medic rapidly intervenes to stop the bleeding. But when the medic's algorithms reach their limit, there is no hospital trauma team waiting behind a set of double doors.

With the nearest hospital miles away, complex medical decisions must be made without delay. It’s in these austere locations that the medics look to an Army physician assistant for expertise.

That responsibility is one reason Sgt. Brent Kendall and Sgt. 1st Class Christopher Soria chose this career path.

They graduated from the Army’s Interservice Physician Assistant Program (IPAP) on June 12 after nearly 30 months of training. Both began their military medical careers as combat medics. And both say their experiences caring for Soldiers shaped how they view the role they are about to assume.

"The medics are looking to you and you're running the show," Kendall said when describing the role Army PAs play in operational environments. "You've been trained to be able to make that sort of decision."

Kendall served as a combat medic in the Nebraska National Guard while also building a civilian law enforcement career. Soria spent 14 years as a combat medic, including time instructing future medics before entering IPAP.

Their years as medics taught them to operate under pressure, but both said the PA role demands a broader set of skills.

"The combat medic is very algorithm based," Kendall said. "It's very much, this is step one, this is step two, this is step three."

But the physician assistant, he said, must go beyond executing a treatment algorithm and determine which diagnosis fits the patient in the first place.

Soria arrived at a similar conclusion during training.

"As a medic, you get trained to follow an algorithm," he said. "As a PA, there's still algorithms, but you don't know which algorithm you're going to fall into until you actually see the patient."

The transition challenged both students to develop new ways of thinking.

"It is more critical thinking and trying to figure out what the problem is," Kendall said. "This is the information that I have. What do I think it is? How do I rule this out? What's the next step?"

CPT John Zamora, the IPAP Phase 2 Program Director at Irwin Army Community Hospital, said bridging that gap is central to the curriculum. While IPAP now trains Soldiers from non-medical branches like infantry and engineering, transitioning former combat medics requires a specific approach.

"We transition them by constantly challenging each student with the question, ‘Why?’” Zamora said. “They can no longer just execute a step in an algorithm, they must defend the pathophysiology behind the symptoms, understand the pharmacology of the drugs they prescribe, and anticipate how a disease process will evolve. We aren't teaching them what to do anymore, we are teaching them how to think like a clinician.”

During clinical rotations at Irwin Army Community Hospital, both students worked under the supervision of experienced providers. Graduation, however, will bring a different level of accountability.

"I have the protection of my preceptor," Soria said. "He or she is watching me, making sure I'm not making any mistakes. But after graduation, I'll kind of be on my own."

Kendall said the realization became particularly clear during emergency medicine rotations.

"Here I'm in student status," he said. "I can always ask somebody. But in future environments, people will be coming to you with those questions."

To prepare students for this isolation, Zamora said preceptors use "mentorship-led autonomy," gradually stepping back so students must formulate their own diagnoses and treatment plans.

“Preceptors will then have students explain the reasoning behind their clinical decision-making,” Zamora said, noting they discuss the second- and third-order effects of those choices. “The latter is especially important to further educate the students on treatment if an evacuation is delayed and how to properly manage the patient.”

But expectations extend beyond clinical care.

Army PAs advise commanders, evaluate readiness, manage profiles, and help determine whether Soldiers are fit to train and deploy. Soria said those responsibilities distinguish military practice from many civilian healthcare settings.

"As a PA in the military, you're still expected to see patients," he said. "But at the same time, you have things on the side that the military has to deal with like profiling, preparing for deployments, field training exercises."

From a readiness perspective, Zamora noted this is where the prior service experience of IPAP students makes a difference. When they graduate, they don't just bring clinical expertise to their battalion, they bring years of military leadership.

“They already know how the Army works, how Soldiers think, and how to advise a commander,” Zamora said.

While both students acknowledged the demands of the profession, they repeatedly returned to the theme of service.

For mid-career Soldiers like Kendall and Soria, the accelerated timeline of IPAP offers what Zamora calls "operational continuity." Rather than disappearing from the operational Army for a decade in medical school and residency, the PA route allows them to return to the line in just two and a half years.

"By choosing the PA path, they fast-track their ability to provide high-level, autonomous care directly to their brothers and sisters in arms, maximizing their impact where it matters most," Zamora said.

Kendall said his decision to pursue the profession was tied directly to his desire to continue serving Soldiers.

"I specifically want to do it in the military setting," he said. "I chose to enlist. I chose to serve. It was something I wanted to do."

Soria described a similar motivation.

"I just enjoy overall working with the Soldiers," he said. "I enjoy building those connections with them."

He said some of the most rewarding moments of his career came from helping Soldiers through difficult circumstances and watching younger medics develop professionally.

"I would love to go back as a PA," Soria said. "I enjoy seeing the medics grow and learn."

Both are now preparing to trade their student status for the operational force. For Kendall, that means joining a battalion in the Nebraska National Guard. For Soria, it means continuing a career devoted to mentoring the next generation of Army medics.

On June 12, the safety net of the hospital will vanish. The preceptors will stay behind. The next time a combat medic kneels in the dirt, reaches the limit of an algorithm, and looks up for the final medical authority, they won't be looking for a set of double doors. They will be looking at Kendall and Soria.