In the 50 years of the physician assistant (PA) profession, PAs have worked hard to establish themselves in the workforce as flexible and caring clinicians who can increase health care access, decrease health care costs, improve the efficiency of health care systems, and advance the health care quality movement. Our success in clinical roles has been well documented. Unfortunately, PAs have not always viewed themselves as the leaders they could be. This chapter is intended to provide background, information, guidance, and examples for PAs and PA students beginning their leadership trajectory.
Selecting and admitting leaders
The admissions process for PA programs identifies individuals whose priority is to provide clinical care. The acquisition of clinical knowledge, skills, and attitudes is emphasized. Traditionally, the importance of leadership skills in prospective PAs has been less important in the admissions process. More recently, however, PA programs have begun to evaluate the potential of PA applicants to hold leadership roles and are factoring leadership into the selection process. Programs are also working to develop leadership and advocacy skills in their students. PA programs at the University of Southern California, George Washington University, and the University of Colorado all arrange for students to conduct visits with elected leaders in Washington, DC. In addition, the Physician Assistant Education Association has a health policy fellowship in which students are trained in both leadership and advocacy skills.
Leadership for clinicians
For clinicians, leadership is often defined too narrowly as encompassing only medical settings. PAs and students have long served with organizations like the American Academy of Physician Assistants (AAPA) and state constituent organizations of AAPA. They have also provided leadership in special interest organizations like the Society for Point of Care Ultrasound or PAs for Global Health. It is also important, however, that PAs look at leadership in a larger context. PAs can lead in community organizations, educational institutions, sports, and even politics! It‘s important to see leadership skills as transferrable. Skills and behaviors learned as a committee participant, board member, or officer in any organization can be transferred to other settings.
Physician assistants in leadership
California Congresswoman Karen Bass is an excellent example of PA leadership. In addition to being a PA and a former PA educator, she was a community leader in health care access advocacy. Based on her experiences as a health care advocate, she ran for the state legislature, ultimately rising to the level of the Speaker of the California State Assembly. As speaker. Bass worked with colleagues to address a significant budget deficit in California, conducting bipartisan negotiations in the face of substantial constituent pressure to not compromise. For her work, she won the John F. Kennedy Profiles in Courage award in 2010. In 2010, she ran for the United States House of Representatives, where she still serves as the first PA in Congress.
PAs have achieved many significant leadership roles within the military. Epifano Elizondo, PhD, PA-C, the 2017 winner of the AAPA Eugene Stead Jr. Award for lifetime achievement as a PA, is the highest-ranking PA in the U.S. military. He has served in the Navy, Air Force, Army Reserves, and the U.S. Public Health Service, ultimately reaching the rank of Rear Admiral, upper half. He led disaster responses to Hurricanes Katrina and Rita and also has provided leadership for the U.S. military response to Ebola. The first PA to reach any flag rank was Michael R. Milner, DHSc, PA-C. He was appointed a Rear Admiral and Assistant U.S. Surgeon General. Throughout his career, his leadership has included disaster coordination roles and clinical research positions with the Indian Health Service. In 2012, he was the recipient of the U.S. Public Health Service Distinguished Service Medal. He has also served for many years in the AAPA Veterans Caucus.
Leadership is important for PAs at all levels. Leadership brings increased visibility and credibility to the profession. It also creates opportunities for PA input into policies and implementation. We have a lot to offer! Our goal should be to have a PA in every administrative structure where physicians are typically seen or represented. Too often, clinicians deprecate administrative roles and leadership as tainted and thankless tasks. The attitude is, “Someone’s got do it, but it isn’t going to be me!” This view fails to consider the opportunity to improve situations, both in the long and short term, for patients, clinicians, and the larger community.
In reflecting on their careers, many senior PAs say they are astounded at the opportunities that were made available to them. These PAs recount stories of being drawn into leadership positions, even though this was never their intention. They also recognize the contributions they have made, so they pride themselves on having “never said no” when faced with a leadership invitation. They didn’t want to limit themselves or to limit the contribution that PAs can make in both clinical and nonclinical settings.
A major advantage that PAs have in assuming leadership roles is that we are already experienced in asking for help. PAs see this as a strength, not a weakness! In a new administrative or leadership role, it is good practice to ask a lot of questions about everything from the history of the organization to unique terminology to the roles of everyone in the group. A first priority should be to schedule individual meetings to better understand the organization, its policies, and the cast of characters. Charging in to make changes without understanding the way the organization worked before you came is a recipe for disaster. Not only might you exacerbate existing problems, but you are also likely to lose credibility with those who have been involved with the organization for longer than you have.
A leadership skill set for physician assistants
The role of leaders is often mischaracterized as simply being the public and political face of an organization. This inaccurate view of leadership may also see some types of activities (e.g., officer or board member positions within an organization) as rewards or popularity contests rather than as work to be done. In fact, the skill set for an effective leader—at either the junior or senior level—includes processes to be understood and mastered rather than tasks to be checked off ( Box 58.1 ). In reviewing this list of skills and processes, most PAs are quick to notice the overlap with clinical workups, diagnosis, treatment, and follow-up. As PAs, we are used to gathering information, problem solving, and getting things done. That’s what leaders do!