New President of AAPA Shares Vision for Physician Assistant Profession

Jennifer Orozco sees physician assistants as a vital part of care teams and expects continued growth of the profession.

The new president of the American Academy of PAs (AAPA) is bullish on the future of the physician assistant profession.

Jennifer Orozco, MMS, PA-C, began her AAPA presidency on July 1. She practices in vascular surgery and serves as director of advanced practice providers at Rush University Medical Center in Chicago.

Orozco spoke recently with HealthLeaders about a range of issues, including the agenda for her AAPA presidency, the role of PAs in care teams, and her vision for the future of the PA profession. The following is a lightly edited transcript of that conversation.

HealthLeaders: What are the primary elements of your agenda as president of the AAPA?

Jennifer Orozco: There are three things that are important to me and many in the PA profession.

First is patient access to care. We continue to have major patient access issues across the United States.

Second is removing barriers to PA practice. PAs cannot be part of the solution to improve patient access to care until we remove antiquated legislative and regulatory barriers.

Third is a focus on mental health, which is one of my passions. I have been knee-deep in the coronavirus pandemic for the past 18 months in Chicago. I have seen the effects not only on the patients but also on the healthcare workforce. I want to shine light on mental health and remove the stigma.

HL: Are there particular restrictions on PAs that you would like to target?

Orozco: There are only three states that remove a specific relationship with a physician for PAs to practice. In every other state, PAs must be tied legally to a physician filed with the state. There is a lot of paperwork associated with this requirement.

This requirement does not accurately reflect how we have practiced for more than 50 years, and it has been a huge barrier during the coronavirus pandemic. Our profession is flexible, and PAs are generalists, so they can move to different specialties. But we often could not move them during the pandemic because there were so many regulatory barriers. Many governors issued executive orders to remove the requirement that PAs be tied to a physician at the state level. This allowed us to move PAs who were trained to take care of critically ill patients across state lines to coronavirus hotspots.

PAs are highly trained. They have many hours of clinical training as well as administrative training. They do not have as many years of training as a physician, but they are next in line in terms of training.

Another area I would like to address is allowing PAs to govern themselves in the states and have PA boards. We would not have a physician board governing all the nurses in a state. The nurses do that for themselves. We have more than 150,000 PAs in the country, and they should be governing their profession because they know their education, training, and background.

HL: How have PAs played a role in responding to the coronavirus pandemic?

Orozco: Like all frontline providers, PAs have had a very challenging 18 months. They have not only been trying to take care of COVID-19 patients, but also trying to make sure that the basic healthcare needs of their own patients are met. But this is what we are trained for. When there is a crisis, our commitment to patients is stronger than ever.

The AAPA put out a survey in 2020 that showed three out of five PAs had tested, diagnosed, or treated COVID-19 patients. For PAs, the key during the pandemic has been our ability to be flexible.

As a healthcare administrator my life was made easier because I was able to take PAs and move them to wherever I needed to. I knew they had the education, the training, and the skillset to take care of COVID-19 patients, whether it was testing, critical care in the ICU, or care in the emergency department. Wherever there was a need, I knew there were PAs who were trained and ready to go. During the pandemic, PAs became part of the "go to" workforce.

HL: How should PAs fit into care teams at physician practices?

Orozco: The most successful clinical teams are the ones that utilize the skillsets and the abilities of each individual team member to the fullest extent. No single person cares solely for a patient. It is not just a doctor. It is not just a nurse. It is not just a respiratory therapist. Every single team member brings a skillset and an expertise. That is the way healthcare is delivered, and the PA profession was founded on the concept of collaborative practice.

PAs fit into the team-based healthcare model. We have the training to care for the patient from start to finish. Evidence has shown that the most successful teams are the ones that decide what works best for them. We need to allow teams to be flexible.

HL: What is your vision for the future of PAs?

Orozco: The PA profession was named the Number One job by U.S. News & World Report this past January. That demonstrates that patients and employers know and value the PA role. The profession is expected to continue to grow. The federal Bureau of Labor Statistics estimates that PA employment will grow 31 percent from 2020 to 2030, much faster than the average for all occupations.

As PAs continue to grow, we can help improve access to care and provide high quality care despite the gaps that we have seen during the pandemic. We have an aging population, healthcare is complex, and patients need a comprehensive approach to medicine, especially in the primary care arena, where we have challenges getting enough physicians.

Additionally, PAs are leadership trained, so I envision PAs serving in leadership roles across all medical settings and specialties. These leadership roles could be at medical centers, departments of public health, and at the state, regional, and national levels.

HL: What advice do you have to offer to new PAs?

Orozco: It is a difficult time for new PAs. We are surviving a pandemic. New PAs were in school during a global pandemic, which is unprecedented.

Given the mental health pressures of the pandemic, my advice to new PAs is you must take care of yourself first. You cannot care for other people if you are not taking care of yourself. Provider burnout among PAs, physicians, and nurses is serious and devastating. Burnout has been an issue for many years, but the pandemic has elevated the problem. PAs need to prioritize their mental health and wellbeing so they can deliver healthcare to patients.

I also encourage new PAs to look for ways they can innovate as well as lead healthcare teams. Do not be afraid—be bold. Go out and deliver the healthcare that you are trained to do. We also need to keep the patient-centered focus at the core of all that we do.

New PAs should not get lost in their administrative duties and their student loans. If you keep the patient focus at the forefront, along with your mental health and wellbeing, you are going to be a successful PA throughout your career.