Introduction
Physician assistant (PA) education is modeled on the broad, generalist design of physician education. PA students learn each organ system and how they interrelate as a whole body system to promote health and well-being or to cause alterations in function. Students also learn about population-based and systems-based delivery of health care. Most PA students spend their clinical experiences “rotating” through selected medical and surgical specialties to obtain the breadth of knowledge that has led to the success of our profession. Although this education system prepares a student well to enter into many disciplines, new graduates may perceive that they are a “jack of all trades but master of none.” This breadth of knowledge provides flexibility to individual PAs as they navigate through their careers; however, it can present obstacles for the PAs who wish to develop a unique clinical focus that may add value to their practice and allow them to excel as a clinician. This chapter will explore one way that a PA can add value to their practice: the development of a PA practice niche.
As science advances and more is learned about each disease process, the practice of medicine and the delivery of health care continues to become increasingly complex. Physicians have responded to these changes by developing more specialized practices. As a consequence, many physicians spend a significant amount of time after residency completing fellowships that provide subspecialty training. No longer are patients simply treated by an orthopedic surgeon; instead, they are treated by an orthopedic knee specialist. Patients with uterine cancer are increasingly treated by a gynecologic oncologist instead of a general obstetrician-gynecologist. With the increasing depth of knowledge required for subspecialty practice, how can generalist PAs distinguish themselves? They certainly can increase their depth of knowledge in one specialty field of medicine; however, they can also develop a niche that either complements those of their collaborating physicians or brings a whole new dimension to their practice.
What is a physician assistant practice niche?
Simply defined, a niche is a position particularly suitable for the person occupying it. In our context, a niche represents a position within PA practice that is particularly suitable for the talents and skills that an individual PA may already possess or those they wish to develop. A practice niche may represent a specialty within a specialty, such as a PA who practices solely labor and delivery within a larger obstetrics and gynecology group, or it may represent a specific skill that a PA has developed over time, such as point-of-care ultrasound, that may be applied to several different practice settings. PAs and PA students should always be vigilant to identify ways of improving patient outcomes by considering whether there is a need for a particular knowledge base or skill within their practice. Cultivating a practice niche is one way PAs can distinguish themselves among the ever-growing fields of specialty care, increase their value to both their individual and group practices, and improve patient outcomes along the way.
Discerning your niche
Many students enter PA school with previous experience in health care, and this experience can be cultivated to form a practice niche. Students should look to further develop their pre-PA skills while in PA school by working with members of the health care team beyond preceptors to learn or enhance their skills. Orthopedic or plastic surgeons may be willing to teach how to administer regional anesthesia blocks or how to suture more effectively, for example. While you are a student, you should leverage all the clinical expertise around you to enhance your education. You have been given a unique opportunity to learn as a student. Make the most of your time, for very soon you will be required to continue to educate yourself while practicing as a PA and balancing all the demands of a full-time clinician. While in school or out on clinical experience rotations, ask yourself what interests you, what excites you, and where do you feel a passion growing inside? Perhaps there is a concept that is unclear or confusing to you. Read up on that concept and ask your preceptors for clarification. Have you noticed a deficiency or perceived a need that seems to be common within some of your rotation settings? Ask the people around you if they perceive the same need and ask them for ideas to address the problem. Take initiative and be that self-directed learner!
When you begin your job search, look for opportunities within each potential job you are considering to find your own niche. During the interview process, ask about new initiatives started by the group and whether the practice or hospital service is seeking any specialized skills. Ask the physicians about their vision for the development of the practice and see if it includes offering new services that you may be able to provide. Research the practice or hospital system, analyze it, and try to identify a skill that might bring value to the group. Be creative. You will have more opportunities after graduation as a full-time member of a clinical group to develop a skill. Perhaps you worked as a medical technologist and you are noticing inefficiency or misuse of laboratory tests by others in your practice. Use this as an opportunity to educate your coproviders or to recommend improvements in process. Perhaps you were an emergency medical technician and developed a proficiency for many procedures. You might use these skills in a family medicine practice to offer a workshop or to become the procedure “specialist” in the group. The possibilities are limitless.
Developing your niche
Be patient and persistent. Developing unique skills and a niche takes time, often years. You will need to continually learn to keep up with new developments in the field. Don’t be discouraged if you start down one path only to find that you need to change directions. Keep an open mind, stay connected with members of your health care team, and allow your clinical experiences to guide you. Use your professional development funds to attend workshops, seminars, and short courses. You may begin by attending short workshops that are part of a national conference and when you begin to have a vision and see your goal, move to attend seminars and more lengthy courses. Seek advice and help from other specialists in your scope of practice. Show interest in the other members of the health care team. Spend time learning outside your regular working hours. Most people enjoy talking to others about their unique skills. It may be your respiratory therapist or social work colleague who connects with you for a novel idea. Develop a vision and establish a goal. When we don’t have a destination, we can wander aimlessly.
PA profiles
We have interviewed three PAs who have established niches within their PA practices. Read their stories and reflect upon their journeys as you begin to develop your vision.
Randy Brush MS, PA-C – family medicine
Randy Brush MS, PA-C ( Fig. 57.1 ) found his niche out of compassion for his patients. Diabetes patients in his corner of Indiana were faced with a 3 to 6 month wait to see an endocrinologist. Many of his patients in his family medicine practice were struggling to manage their glucose and facing consequences of uncontrolled diabetes. Randy did not want to make them wait to begin to improve their lives. He began to study and develop his own knowledge and skills in diabetes management. He started researching the pharmacology of medications used to treat diabetes and going to every CME meeting he could find that would help him provide better diabetes care. He also started learning more about the role of different types of diets for patients with diabetes. He learned how to educate patients on the role of carbohydrates in diabetes and how to count carbohydrates for better diabetes care. He would tell his patients, “There is a 3 to 6 month wait for you to see an endocrinologist, so let’s see what we can do for your diabetes while you are waiting. Our work together will give the endocrinologist more data on which to base decisions about what will work best for you.”
