Miranda knew during freshman year of college that she wanted to pursue a career in healthcare. Although registered as pre-med, she was unsure of which profession. For a while, she thought physical therapy but it didn’t seem to be the right fit. During this time of indecision, her uncle was being cared for at the Fargo VA for esophageal cancer. He asked her what she wanted to do and Miranda mentioned she had not yet decided. He said, “Be a PA! They treat me better than any of the physicians here.” Her immediate response was, “What is a PA?” After returning home, she researched the profession and realized “this is it, this is what I want to do.”
After deciding that PA school was the next step, she needed to prepare her application. Fortunately, she had been accruing patient care hours as a certified nursing assistant for quite some time. During high school, the local nursing home was desperate for help so she received a crash course from a family friend. When she turned sixteen years old, she signed up for the exam, passed and began working immediately. By the time she applied, Miranda had six years’ worth of experience. Her degree in cell biology was a testament to her academic readiness.
Miranda applied to about 8 schools across the country, but Augsburg was her first choice. She was thrilled when she was accepted as she wanted to remain close to family. During her second rotation, she was placed at the Twin Ports VA Clinic in Superior. Even though this was only the beginning of her clinical education, her preceptor encouraged her to reach out if she was interested in a job. Throughout the clinical phase, Miranda constantly compared other rotations to her experience at the VA.
At the time of her PA graduation, the 2008 economy had crashed leaving few options for employment. Miranda wanted to return to the Northland but jobs were limited there as well due to the local health system laying off employees. Her options were a posting at a convenience care clinic and one at the Twin Ports VA. Miranda was hopeful she could return to the VA and serve the patient population she fell in love with.
Even after ten years in the same clinic, Miranda finds joy in being a PA serving veterans. Working with this population inspires her and gives her a purpose to serve patients who Miranda says have all been brave enough to do something she couldn’t. She appreciates the real sacrifice her patients have made so that she can live her life in the United States. Every day she is able to establish rapport, gain trust and surprise people. She loves when a new patient is referred to her and they decide to transfer their care.
Veteran medicine is challenging, but it is so rewarding. She believes she is able to practice medicine in the most ideal way. Patients do not need to worry about prior authorization which translates into patients receiving prescriptions, surgeries and referral services. Miranda is able to control her schedule and has incorporated telephone clinics, secure messaging, group visits along with various patient panel management tools. She can pull specific lists based on patient populations such as diabetics with an A1c greater than 9 and then implement ways to improve their overall health. In October, COPD patients attend an annual group appointment and Miranda can do the same for patients diagnosed with hypertension, DMII, or prediabetes. The Twin Ports VA Clinic has integrated mental health within the primary care setting as well as operates a “medical home” model that is called Patient Aligned Care Teams (PACTs). All of these capabilities lead to nearly 100% continuity of care.
Throughout her tenure she has seen great strides in the roles PAs occupy including a clinic director, as well as in upper management and administration. Miranda was promoted to chief status in the fall of 2018 and she appreciates the recognition that her clinical skills have grown and the administration noticed.
When asked what advice she would give current students, Miranda says, “Know that it is okay not to know everything.” When a patient comes in with a question, concern or new condition she is honest and says “I don’t know, let’s look it up together.” This helps to establish rapport with a patient and the relationship-building can begin.