PRACTICING PAs • BY BIANCA BELCHER, PA-C

From Anne: I first came across Bianca when she kept a blog about her journey through PA school. Since then Bianca has done tremendous work in education, research and PA leadership. She kindly agreed to write a post about the importance of PA leadership.

Bianca is a director for CHLM. She brings expertise in practice growth strategy, improving work flow efficiency, and in the development and implementation of education curricula. Bianca has spent her clinical career as a hospital-based PA in the department of neurosurgery at Brigham & Women’s Hospital in Boston practicing in the outpatient, inpatient, and operating room arenas. In addition to her clinical work, she holds academic positions at Harvard Medical School, Northeastern University, and Massachusetts General Hospital Institute for Health Professions. Bianca’s interests include analyzing the use of technology and social media in the delivery of better health services. Bianca completed her master’s in physician assistant studies at Northeastern University and her MPH at Dartmouth.

Leadership as a PA Student – I got involved in leadership as a student through the Student Academy for the American Academy of PAs (SAAAPA). I took part as an assembly of representatives (AOR) rep for my school and then ran for a position on the national student board. This allowed me to interact with several layers of leadership throughout the AAPA organization as well as build a network of other student leaders who have the same aspirations as me. This was really a steppingstone for getting into leadership as a practicing PA.

Leadership as a PA – I was elected to the director at large position for my state constituent organization my first year out of school, which again allowed me to further build my network, gain mentorship from current leadership, as well as become a more informed ambassador for the PA profession at both my institution and on the state level.

The Center for Healthcare Leadership and Management (CHLM) is a subsidiary of the AAPA. It was born out of the advocacy department around 2013- 2014. The advocacy group has been doing a phenomenal job moving the needle towards more positive and PA friendly legislation both at the state and federal level, however we noticed that these changes were not necessarily filtering down to the employer level. Many employers of PAs had outdated bylaws that placed artificial restrictions on the practice of PAs within their institution. CHLM was established to focus primarily on the employer.

Part of our mission is to help employers better integrate PAs (and NPs) into their overall organizational strategy in four key areas: their patients, their providers, their finance, and their risk.

I have been with CHLM for about a year. I enjoy traveling around the country to see how our profession is being utilized and in many cases help with better utilization.

There are several leadership competencies necessary to be successful in any leadership position, however there are a few that are particularly relevant to the PA profession.

1. A deep knowledge about the PA scope of practice your particular area
2. A basic knowledge of billing and reimbursement and how it is similar and different to the other medical professionals such as nurse practitioners and physicians
3. The ability to mentor, we are a young and fast-growing profession and it will be crucial that we are able to mentor new leadership from her own rank-and-file.
4. An understanding of big picture healthcare and the ways in which PAs can fit in and positively impact the bigger picture

There are a few reasons why leadership should be important to frontline PAs.

1. In the United States, we are a rapidly growing profession. We have grown by 44% over the last six years and are projected to grow another 30% over the next 10 years. With such a fast-growing profession it is important that some of us focus on leading our own – if we are not willing to do it, we can’t complain when other professions are positioned as leaders our group such as physicians and/or nurses.

2. Burnout within the medical profession is an ongoing and growing problem. Building up a skill set in addition to your clinical skills allows for some day-to-day variation as well as alternate career paths options within medicine if clinical burnout becomes an issue for you.

3. In the United States, the average age of incoming PA students is younger than ever. When the profession first began the average age of a first-year PA student was in the early to mid 30s, in a recent report put out by the Physician Assistant Education Association (PAEA), the average age of a first-year PA student in 2017 was 25. The youngest of which was 21. When you consider that, the average PA will now practice an additional decade or more than those that came before us. Even if these PAs are not interested in leadership initially, chances are that over the course of their PA career they will find themselves in a leadership position and it is important to have the proper competencies to be successful.

“…if we are not willing to do it, we can’t complain when other professions are positioned as leaders our group such as physicians and/or nurses.”

PAs are one of the very few medical providers that see patients throughout the continuum of care. Many other healthcare providers only see patients in a small portion of that continuum -therein lies our advantage. We understand the healthcare delivery system very well and understand the internal workings better than most. This puts us in a prime position offer well thought out plans of action for quality improvement projects, process improvement, and to improve clinical outcomes.

Unfortunately I do not think we do a fantastic job of teaching leadership within PA programs. I think that this does our profession a disservice. Helping students, early career PAs, and season PAs all see the potential avenues for leadership is crucially important if we want our profession to continue to flourish.

At CHLM we look at five pathways to leadership. Clinical. Administrative. Education. Research. Other.

1. Clinical: clinical leadership is based on ensuring optimal care for patients and overcoming problems in the clinical workspace or healthcare delivery system. Clinical leader focuses on becoming an expert in a given medical or surgical specialty, patient population, procedure, treatment pathway, and or protocols.

2. Administrative. These leaders utilize leadership and management competencies above and beyond their clinical skill set to positively impact patient care. These leaders are aspiring or experts in the business of medicine, clinical quality, compliance, staffing, and revenue cycle management.

3. Education. A leader in education focuses on the creative, comprehensive, and technical education, the educational process, and or the preceptorship of future medical professionals (including but not limited to PAs).

4. Research. These leaders or primary investigators may lead and manage a research team, secure new research grants, publish, respond to institutional issues and agendas, and/or maintain and develop their own research expertise.

5. Other. The other category is inclusive of many other pathways for leadership including entrepreneurship, industry, consulting, volunteer leadership, etc. Entrepreneurial leaders have or seek to design, launch, and run a business utilizing their PA skill set. Leaders in industry provide clinical consultation and education to those in industries that support providers and the clinical delivery system. Volunteer leadership consists of those that volunteer their time and expertise on Association boards, state medical boards, and committees to positively impact the Association and/or constituents.

I get this question often.

As I mentioned above there are several pathways to potential leadership positions. And MPH is incredibly helpful in some but not all of those pathways. An MBA or M HA may be a better option depending on what you want to do.

My advice for additional education is: #1 figure out what your ultimate leadership position goal is #2 then figure out what specific skill set you need to get there #3 look at the options for getting that specific skill set (for example – do you need an advanced degree? Could you just take some individual classes online to get those skills without paying for full degree? Are there courses offered through a national Association that may help you gain the skill set and the network?).

Leadership and mentorship do not live in silos. It is important to develop these things within the PA profession, but it is equally as important for PAs to integrate into existing leadership and mentor pathways for other groups (physicians, nurses, administrators). This helps build interprofessional relationships and increase the credibility and recognizability of PAs across the spectrum.