The first job I took out of school was in Alpine Texas in the remote rural border area of West of West Texas. I settled in Marfa Texas 25 miles away. I did this so that I could work in an under served area, learn practice and work in Spanish, and work in a practice that had a wide variety of patient contacts. We do everything out here, the closest specialty referral is 200 miles away so I learned a lot. I worked with a supervising M.D. who ran a medicine mill so I learned what not to do. Fortunately I worked with an Air force PA a 30 year PA named Sonny Benton who taught me everything I needed to know by both example and caring instruction, Thank you Sonny.

My next job was a Solo Clinic in Presidio Texas on the border with Mexico. This was a solo practice with the nearest M.D., ER, or clinic facility being 80 miles away. I cared for the citizens of Presidio, a town of 6,000 along with the Mexican Town of Ojinaga Chihuahua 24,000 many of them Medicare or Medicaid patients.

After doing this for a year I moved to New York City where I fulfilled a professional goal of working with AIDS. I got a Job with an agency called the Foundation for researched on Sexually Transmitted diseases. Again I was essentially thrown into the fire with a solo type practice. There was a quick succession of three supervising doctors, I left after a year and a half for a more stable supportive practice at the New York Presbyterian Hospital.

The youth program at NY Presbyterian Hospital is called Project STAY, Services To Assist Youth. and is by far the best job I've ever had. STAY is a program for youth 14 to 24 YO with HIV and AIDS. An adolescent practice is like herding cats, the challenges of attention span, feelings of "immortality" along with "knowing it all" makes it a challenge to work with this age group. Making a medical intervention on Teens is particularly important because the patent's interaction with our program sets the pace for their entire "AIDS career" the skills and perspective that they gain on medication compliance, sexual safety, nutrition, and insight about their disease state profoundly impacts morbidity and mortality for the rest of their life. It was my pleasure to be the "on call PA" and the PA that patients saw at our weekly clinics. I was also in charge of outreach which consisted of school and community education programs and presentations that culminated in on site STI and HIV testing.

I left this job to return to Marfa Texas Where I am the PA at a solo practice in a new FQHC clinic that is two years old. Marfa is a town of 2,400 people and we catch a wide area around Marfa as well. I work in Presidio 60 miles away once a week, the practices are essentially family medicine. My wife Valerie works at an Arts organization in Marfa we have two kids Victor 3 years old and Louise 3 months old. We live on the edge of town and are beginning to work the land with small scale cultivation and live stock. While it is particularly challenging being the only show in town medically, it is rewarding to live in a rural remote peaceful community.

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