Grant Funds PA Student Rotations in Rural Clinics Integrating Primary Care, Mental Health

Physician associate students from the University of Oklahoma Health Sciences campus are embarking on three-month rotations in rural primary care clinics that integrate mental health services into their practices. The initiative aims to grow the PA workforce across rural Oklahoma and equip them with skills to address mental health concerns before patients ever leave the building.

Oklahoma has a significant shortage of both primary care and mental health providers, especially in rural parts of the state, where about 41% of the population lives. Because PAs are licensed to practice medicine with the supervision of a physician, they are uniquely positioned to extend the reach of medical care, and in Oklahoma, PAs can prescribe medications. In rural areas, primary care providers are often the first line of treatment for any type of health concern, making mental health care skills especially important.

“Our goal is to increase the number of trained PAs who choose to practice in rural areas of Oklahoma after they graduate. Right now, about 23% of PAs employed in Oklahoma practice in a rural setting, but studies show that when students are exposed to rural health care, they are more likely to practice there,” said Darlla Duniphin, interim director of the PA program and project director for the grant. “About 95% of our state is designated as a health professional shortage area, and PAs can help increase access to care.

“In addition, by training in a setting that integrates mental health with primary care, our students are learning the important role they can play in caring for their patients’ mental health. Too many times, a provider suggests that a patient seek mental health care or gives them a referral, but the patient never goes, and they fall through the cracks.”

The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services awarded the OU Health Sciences campus in Oklahoma City a $2 million grant to create the rural rotation program. Much of the funds will help students pay for housing and meals in the rural communities where they stay during their training. To start, three Oklahoma health systems will host students for their rotations: the Okeene Municipal Hospital and Medical Clinic (Blaine County), the Iowa Tribe Perkins Family Clinic (Payne County), and the Health and Wellness Center (formerly Stigler Health and Wellness Center), which has a network of locations across eastern and southeastern Oklahoma.

Each site integrates mental health with primary care services. A primary care provider like a PA may treat a patient for both physical and mental health conditions, or may walk the patient down the hall to connect with a psychotherapist or other mental health practitioner.

Simply asking patients about their mood and energy level opens the door for them to talk about their concerns. “It’s important that we have these conversations with our patients because there is still stigma attached to mental health issues,” said Bruna Varalli-Claypool, co-leader of the grant and PA program faculty member. “It opens the door for them to talk about how they’re feeling. And sometimes they may come in thinking that they will be diagnosed with a migraine or an ulcer, but anxiety or depression are really causing their problems. We are building trust with them and taking care of the whole patient.”

In conjunction with the new clinical rotations, faculty have enhanced the PA curriculum’s instruction on mental health conditions, as well as substance abuse treatment, particularly regarding opioids, which remain a major problem in the state.

Even if PA students don’t ultimately practice medicine in a setting that integrates primary care with mental health care, they will be skilled in caring for both. PAs at OU Health Sciences are intentionally trained as generalists who understand the whole patient.

“We’re starting to understand and focus on the fact that mental health is a huge part of our physical health. Separation of the two doesn’t work. It’s incredibly important to prepare our students to have conversations about mental health with their patients,” said Mary Gowin, a co-leader of the grant and director of the Primary Care Health Policy Division in the OU College of Medicine.

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About the project

Darlla Duniphin, Bruna Varalli-Claypool and Mary Gowin are faculty members in the Department of Family and Preventive Medicine in the OU College of Medicine. Duniphin is an associate professor, a physician assistant-certified (PA-C) and holds a Doctor of Health Science degree. Varalli-Claypool is a professor, a PA-C, and holds a master’s of health sciences. Gowin is an associate professor and holds a doctorate and master’s of public health.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of a five-year award totaling $2 million. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. government.