PAs in management roles.

[Fernwood]

I’m curious as to if there are any PAs who are involved in management roles, i.e. clinic manager, etc. I currently work in an urgent care setting and the new clinic director is a newly minted family practice physician who is simply not doing a good job. I have over twenty years of medical experience in various settings as a PA and a degree in Business administration yet, I cannot get a seat at the table. I have offered some good suggestions for improving clinic flow and in some other areas and each time I am summarily dismissed. Would an MBA give me any clout or would I simply be seen as a PA. Just looking for some input.

 

thanks

[EMEDPA]

Chief of EM at Hopkins is a PA:

https://www.hopkinsmedicine.org/emergencymedicine/Faculty/scheulen.html

 

I was an associate chief of a community ER for 2 years. hated every minute. Responsibility without authority...

[lkth487]

I thought the chair of at Hopkins EM was Gabor Kelen?  I'm not in EM but I've heard of him since medical school.  He's a well known figure with lots of academic accomplishments...unless he recently quit?

 

anyway, minor quibble that has nothing to do with the gist of the thread, because the guy you mentioned is obviously management, and has a lot of responsibilities (executive director of capacity management and critical event response preparedness).

Edited July 25, 2018 by lkth487

[PACJD]

If you are talking about departmental chief PAs or APP directors, they usually come with time and experience with the company. All of the PA/NP directors in my hospital have been with the hospital working clinically for at least 10 years, eventually transitioned out of clinical medicine and working primarily in the administrative role now. Some have MHAs, some have MBAs, some have neither.

I know of a couple of young PAs on the executive board of their respective hospitals, one of them has an MBA and one of them has a JD. They are probably in their mid 30s and work part time clinical, mainly administrative. The former CEO of my hospital was a PA for 2 years many years ago, but got then got his JD and MBA, worked various jobs in the corporate world for several years, and then returned to medicine eventually working his way up to CEO of the hospital. He actually just retired though.

I definitely think that getting an MBA would make you a more attractive candidate to be considered in management, but obviously takes a little luck, the right timing, and some connections. I am all for getting another degree in business and feel an MBA will open up many more opportunities for us as PAs in both the clinical realm as well as in non-clinical healthcare related jobs.

[EMEDPA]

he is the chief administrative officer of the group  and president of emergency medical services, not the ER director. He is the ER director's boss. :

James Scheulen, P.A., M.B.A.

 

Chief Administrative Officer, Emergency Medicine and Capacity Management, Johns Hopkins Medicine

Executive Director, CEPAR
President, Johns Hopkins Emergency Medical Services

[PACJD]

2 minutes ago, EMEDPA said:

James Scheulen, P.A., M.B.A.

 

Chief Administrative Officer, Emergency Medicine and Capacity Management, Johns Hopkins Medicine

Executive Director, CEPAR
President, Johns Hopkins Emergency Medical Services

Wow that is great! I was unaware.

 

[sas5814]

15 hours ago, Fernwood said:

I’m curious as to if there are any PAs who are involved in management roles, i.e. clinic manager, etc. I currently work in an urgent care setting and the new clinic director is a newly minted family practice physician who is simply not doing a good job. I have over twenty years of medical experience in various settings as a PA and a degree in Business administration yet, I cannot get a seat at the table. I have offered some good suggestions for improving clinic flow and in some other areas and each time I am summarily dismissed. Would an MBA give me any clout or would I simply be seen as a PA. Just looking for some input.

 

thanks

I have been practicing for almost 30 years and have had multiple leadership roles over the years. I also have a PhD in Health Administration. I, like you, cannot get a seat at the table. My organization is controlled by NPs, nurses, and physicians and PAs are nearly invisible. I beat my head against the corporate wall for over a year using a number of different tactics and made zero progress. I see many many things that could improve productivity, patient satisfaction, and employee satisfaction but have no voice. 

My last shot may be scheduling a brief meeting with our CEO assuming that is possible. There are so many layers between me and the very few people who can actually make a decision I cannot think of another approach that will get any traction.

Edited July 25, 2018 by sas5814

[sas5814]

"Responsibility without authority..."

 

This is one of the MAJOR changes that needs to be made where I work now. So few people have any authority to make a decision (or they are afraid to) that getting the smallest thing done takes crazy amounts of time.

[Fernwood]

I want to thank you for your replies. There is some consolation in that I’m not the only one frustrated by this issue. I honestly don’t think an MBA will get me or any other PA a seat at the table. I see nurses with far less experience and education being promoted to management positions. This has more to do with a powerful nursing lobby than qualification. 

I will attempt to address this with administration but have little hope of any resolution. The last PA to express concern did not get her contract renewed and was never given a reason?

thanks

[Hope2PA]

It appears, as if easiest route for PA to management is getting RN rather than MBA  or MPH.

[Fernwood]

Sadly, there may be some truth to that. If the NCCPA would actually work on improving the standing of the PA within the medical hierarchy instead of constantly coming up with new CME requirements, i.e. PI and SA nonsense, maybe PAs could gain some of these management positions. Whatever you might think about nursing you have to respect the nursing leadership. Good or bad, the primary objective of the nursing lobby over the past 30 years has been to position the nurse as the second most powerful entity in medicine. Take for example AORN, they have managed to take control of the operating rooms across America. At one point they had implemented regulations dictating the type surgical cap a physician could wear. I believe subsequent studies showed the AORN data to be bogus and we are no longer required to wear the bouffant. 

If PAs really ever want to advance within the medical community we are going to have to dismantle the NCCPA and get a governing body that has the PA best interest at heart.

[sas5814]

You would think for a position in administration in... you know.... health care it might. :-) 

[Fernwood]

Here’s the rub, we seem to have a number of extremely experienced PAs who have been on the front lines of medicine who are summarily overlooked when it comes to management positions. These positions typically are given to ivory tower academic/political wonks who have no true real world experience. I am living this very scenario. A PhD, with significant publication may bring sway in an institutions thinking, but only if those publications promote the agenda of said institution. A PhD is quite an undertaking as a gamble to gain a seat at the table.

lets face it, the PA has positioned themselves as a very bright workhorse who in many instances is the backbone of a practice. We are worked hard then placed back in the barn with little ability to influence the methodology of the practice we keep afloat.

my advice to smart young people is a degree in finance or economics then a duel JD/MBA. You can right your own ticket with this combination. Medicine is so 80’s.

[sas5814]

13 minutes ago, mcclane said:

I would think so. But your situation suggests otherwise? Not every degree does what it might suggest on paper.

My point was on paper I would seem to ring all the bells. Education, clinical experience, leadership experience from the military to the local to the national.

My situation is reflective of a greater set of occurences and some local politics. While there are exceptions PAs are considered clinicians and are invisible to administration otherwise. There are many reasons for this and most have been elucidated in other long threads. 

We tend to stay in clinical roles and, percentage wise, few of us seek administrative roles. Nurses seem to live for the chance to get promoted out of actual patient care and then they bring other nurses up behind them. My organization only wants people who have been with the organization for a long time which I find particularly frustrating because it stifles innovation, promotes group think, and fails to infuse the leadership with new and different  perspectives and experiences.

I am actually considering a "camel's nose under the tent flap" idea. I can't get any traction getting a position at the big table. Why not make a role for myself in the UC system where I work which has a small number of APPs and then start leveraging that to larger roles in the system as I become better known? Maybe I am shooting to high...I dunno. I just know what I have been doing hasn't been working so it is time to do some thing else.

[lkth487]

2 hours ago, Fernwood said:

 

my advice to smart young people is a degree in finance or economics then a duel JD/MBA. You can right your own ticket with this combination. Medicine is so 80’s.

 

 I would rather have the job of food taster at a farm in Chernobyl than do a JD/MBA.  No patients at all?  Sounds horrible.  

Edited July 26, 2018 by lkth487

[Fernwood]

Patient care is fantastic. Sometimes, between all the nonsense imposed by insurers and the administration I actually get do to a little.

[sas5814]

Patient care...what you do between meetings, paperwork, and answering complaints.

[EMEDPA]

40 minutes ago, lkth487 said:

 

 I would rather have the job of food taster at a farm in Chernobyl equipment than do a JD/MBA.  No patients at all?  Sounds horrible.  

agree. You want real power/respect? go to medschool. The lecom bridge + a 3 yr residency would get you more than JD/MBA. If you want a leadership position in a rural area it is not hard to get. I work with an FP doc a few years out of residency who is chief of the ER and chief of staff of the hospital. No one else really wanted to do it. He is good at it, but basically fell into the position as the new guy.

[Fernwood]

10 years ago med school may have interested me. With the way medicine is going today, not a chance.

i think I have decided to try and create an urgent orthopedic clinic within the newly acquired orthopedic practice. I currently work urgent care for a giant healthcare organization that has taken over a small orthopedic group. My background is EM and extensive orthopedic surgery experience. Hoping to make it happen.

[jmj11]

A long time ago, my role was going to be expanded (not by my wishes, as I prefer seeing patients) to an administrative role as "Clinical Director" of a clinic, that employed about 8 RNs. At that time in history (1980s), it was a huge problem. The nurse leader resigned because of the very notion and the others all voiced they would quit if any I or any PA was moved into that position. They had been taught that a PA should never, ever have a administrative position above them.

Eventually my boss backed off and it wasn't a position I was fighting for. But this does reflect the mentality that has persisted, making it difficult for PAs to take administrative roles in organizations that employ a lot of nurses. Of course, many of us have worked in positions where nurses were in administrative positions "above" us. In some ways my wife is now my boss (She is the director of patient services at this hospital, a position, which is always held by nurses). Doesn't bother me as I feel secure in who I am and what I do. But the culture needs to change to give more PAs the opportunity. But I suspect it is more nursing resistance than resistance by MDs.

[Hope2PA]

So true jmj11, I've seen RN's as supervisors over ALL types of health care members who had much more experience and education than them.  However, those two little letters, RN, are all that count.....and the power behind them. 

[Zoeyw]

What @Fernwood says is a good suggestion. But medicine should not go to second place. In the current world, administrative positions are important, however toothless they are. They are the face of many institutions, but this won't exist without cooperation from all. If a candidate knows everything on every page of Organizational Behavior, they still need to understand the delicate nuances of patient care, treatment and handling of all types of staff. 

[ventana]

On 7/24/2018 at 7:55 PM, Fernwood said:

I’m curious as to if there are any PAs who are involved in management roles, i.e. clinic manager, etc. I currently work in an urgent care setting and the new clinic director is a newly minted family practice physician who is simply not doing a good job. I have over twenty years of medical experience in various settings as a PA and a degree in Business administration yet, I cannot get a seat at the table. I have offered some good suggestions for improving clinic flow and in some other areas and each time I am summarily dismissed. Would an MBA give me any clout or would I simply be seen as a PA. Just looking for some input.

 

thanks

I just asked my local hospital system (300 bed community hospital with about 3-4 residency IM, Surgery, Psych, path)

 

Cardio department is 4 docs, 8 PA/NP, and many other departments are following this model

 

 

HR's answer to my question - "there is no progression but you can apply to management jobs which you are qualified......"

 

ugh - we run the roost, make millions of dollars "and have no career progression....."