PAs in Leadership: What do the do? A report from the 2022 PA Practice Survey

© 202 3 American Academy of Physician Associates. All rights reserved. Not for distribution or reproduction. PAs in Leadership: W hat do they do ? A report from the 2022 PA Practice Survey 10/24/202 3 • 2022 PA Practice Surve y PAs in Leadership: What do they do? A report from the 2022 PA Practice Survey 2 | 1 3 © Copyright 202 3 American Academy of Physician Associates. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise without the express written permission of AAPA. Table of Contents Abstract ................................ ................................ ................................ ................ 3 Methodology ................................ ................................ ................................ ............................... 3 About PAs ................................ ................................ ................................ ................................ 3 About AAPA ................................ ................................ ................................ ............................. 3 How to Cite ................................ ................................ ................................ ................................ .. 3 Executive Summary ................................ ................................ ............................. 4 Characteristics of PAs in Leadership ................................ ................................ ........................ 4 Leadership Tasks ................................ ................................ ................................ ........................ 5 Tasks by Leadership Role ................................ ................................ ................................ .. 6 Past and Future Tasks ................................ ................................ ................................ ....... 7 Conclusion ................................ ................................ ................................ ................................ .. 7 Data Tables ................................ ................................ ................................ .......... 8 Table 1. Leadership Role, by Type ................................ ................................ ............................. 8 Table 2. Leadership Role by Career Experience ................................ ................................ ....... 8 Table 3. Leadership Role by Primary Specialty ................................ ................................ ........ 8 Table 4. Leadership Role by Primary Setting ................................ ................................ ............ 9 Table 5. Percent of PAs Currently Participating in Leadership Tasks, by Task ...................... 9 Table 6. Percent of PAs Participating in Leadership Tasks, by Leadership Role .................. 10 Table 7. Percent of PAs Participating in Leadership Tasks, by Leadership Role ................... 11 Table 8. Percent of PAs Participating in Leadership Tasks, by Setting ................................ .. 12 Table 9. Percent of PAs Participating in Leadership Activities, by Activity ............................ 13 Table 10. Percent of PAs Participating in Leadership Mentor Activities, by Activity ............. 13 PAs in Leadership: What do they do ? A report from the 2022 PA Practice Survey 3 | 1 3 © 202 3 American Academy of Physician Associates . All rights reserved. Not for distribution or reproduction. Abstract PA leaders are an important part of healthcare systems across the country. However, little is known about the leadership roles PA are performing within their organizations . In this second brief in a three -part series on PAs in leadership, we examine these leadership tasks . Methodology Data were collected in the PA Practice survey fielded quarterly over 2022, sent to approximately 30,000 PAs in the United States (U.S.) who had not opted out of AAPA research surveys for which AAPA had a valid email address. A series of questions related to PAs actions in a leadership role were included within the AAPA’s PA Practice Survey. A total of 29,711 emails were delivered, 4,087 responded (response rate 13.8%) to the invitation, and 3,645 completed the full survey. The overall survey margin of error is +/ - 1.42 % at a 95% confidence level. Response rates and margins of error vary by section and breako ut. “N” refers to the number of respondents and is generally the first column in the data tables. Totals do not always add up to 100% due to rounding. This research is exempt form IRB approval in accordance with US Department of Health and Human Service's Policy for Protection of Human Research Subjects listed at 45 C.F.R. §46.104(d)(2)(ii). The author has no conflicts to report. About PAs PAs (physician associates/physician assistants) are licensed clinicians who practice medicine in every specialty and setting. Trusted, rigorously educated and trained healthcare professionals, PAs are dedicated to expanding access to care and transforming health and wellness through patient -centered, team -based medical practice. A PA’s specific duties depend on the settings in which they work, their level of experience, and state law. There are approximately 159,000 PAs in the United States, who engage in m ore than 514 million patient interactions each year. To learn more about PAs, go to aapa.org. About AAPA Founded in 1968, the American Academy of Physician Associates is the national professional society for PAs (physician associates/physician assistants). It represents a profession of more than 159,000 PAs across all medical and surgical specialties in all 5 0 states, the District of Columbia, U.S. territories, and the uniformed services. AAPA advocates and educates on behalf of the profession and the patients PAs serve. We work to ensure the professional growth, personal excellence, and recognition of PAs. We also enhance their ability to improve the quality, accessibility, and cost -effect iveness of patient - centered healthcare. How to Cite PAs in Leadership: What do they do ? 202 3. American Academy of Physician Associates. Alexandria, VA. https://doi.org/ 10.5281/zenodo. 17953483 PAs in Leadership: What do they do ? A report from the 2022 PA Practice Survey 4 | 1 3 © 202 3 American Academy of Physician Associates . All rights reserved. Not for distribution or reproduction. Executive Summary Within the PA profession, leadership roles can function as a pathway for career advancement, opportunity for workplace task diversification, and a chance to mentor the next generation of practitioners. Despite the importance of PA leadership, few studies examine the demographic characteristic of PA leaders, how they get into leadership roles, or what they do within these positions. To fill this gap, AAPA has developed a series of data briefs to serve as a primer for those interested in learning more about P A leadership. In our second report of the series, we examine the tasks performed by PAs serving in leadership roles . Characteristics of PAs in Leadership Leadership comes in many forms. Within PA leadership, PAs may serve in a formal leadership role which traditionally includes a formal title, additional compensation, and/or a greater number of leadership responsibilities. PAs in leadership roles may have t itles such as Director, Manager, Vice President but may also have a title of Physician Associate or Assistant. In 2022, 40% of PAs indicated they were currently in a formal or informal leadership role. Almost 30 % of PAs were not in, or not interested in, l eadership (Figure 1, Table 1). Seven in 10 PAs who were interested in leadership have less than 10 years of experience. Most of the PAs in formal leadership had over 10 years of work experience (70.8 %, Table 2). More information on the demographics of PAs in leadership can be found in PAs in Leadership: Who are they? Figure 1. PAs by Leadership Role Almost half (46 .2%) of the formal leadership PAs were in primary care or “other specialties” , 21% reported working in a surgical subspecialty , and approximately 1 in 10 indicated practicing in “no medical specialty” (11 .2% , Table 3 ). The two settings with the most leadership PAs , across all leadership roles , were Hospitals and Outpatient clinic or physician office/college clinic. One key area of difference was the proportion of formal leaders working in universities as educators (Table 4 ). Here, almost 1 in 10 (9 .4%) of th e PAs who reported working in formal leadership were educators in a university. PAs who were not 16.6 22.7 22.9 8.2 29.5 0 5 10 15 20 25 30 35 Formal Leaders Informal Leaders Interested in Leadership Former Leader Not Interested in Leadership Percent (%) PAs in Leadership: What do they do ? A report from the 2022 PA Practice Survey 5 | 1 3 © 202 3 American Academy of Physician Associates . All rights reserved. Not for distribution or reproduction. in, or not interested in, leadership were more likely to work in an outpatient clinic or physician office (5 7.9%) than formal leaders, informal leaders, or those interested in leadership. In the 2022 AAPA Salary Survey, we asked PAs in informal leadership positions to describe the leadership activities they performed within their organization. T hree prominent themes emerged from these descriptions (Figure 2). First, informal leadership can involve educati ng, onboarding, or training of new PAs. Second, it may include serving on committees, such as being a member of a hospital wellness or DEI committee. Finally, unofficial supervisory duties in a medical team, such as in a short -staffed depart ment, were also considered informal leadership tasks. Figure 2. Example Quotations Illustrating PAs in Informal Leadership Role Descriptions Educating , Onboarding , & Training Service on Committees Unofficial Supervis ory Duties “The 'go to' person to answer questions … I have been called 'the glue' that holds the team together “ “Chairperson of Center -wide APP committee, but no admin time or compensation. “ “Supervising staff but not their direct supervisor and no ability to hire or fire. “ We aimed to better understand the tasks PAs in informal leadership , and all forms of leadership, reported performin g during the 2022 PA Practice Survey . Roughly 3 in 10 PAs supervising or managing non -clinical staff or onboarding new PAs regarded themselves as informal leaders (Table 6). This may be because 45.9% of the PAs who are helping with onboarding PAs were informally assigned this task , compared to 35.1% being formally assigned the task (Table 9). In the following sections, we take a closer look at the distribution of tasks across formal and informal PA leader s as well as PAs who are interested in leadership . Leadership Tasks Educating others in your practice (not including precepting) was the most frequently cited leadership task that PAs were currently performing in their place of work . A majority (51.6%) of PAs were performing this task. Similarly, many tasks related to mentoring and educating such as serving as a mentor (45.4%), precepting PAs (43.9 % ), and helping onboard PAs (43.6%) were also frequently selected. Two in 5 PAs (40.7%) were serving on a committee , rounding out the top five most cited leadership tasks. Many of the least cited leadership tasks were related to administrative roles. Only 1.2% of PAs were currently serving as union representatives or steward s. However, slightly more PAs were managing budgets (8.6%), participating in PA credentialing (12.5% ), chairing a committee (15.1%), or making hiring and firing decisions (15.4%; Table 5). PAs in Leadership: What do they do ? A report from the 2022 PA Practice Survey 6 | 1 3 © 202 3 American Academy of Physician Associates . All rights reserved. Not for distribution or reproduction. Tasks by Leadership Role To gain additional insights, we examined the leadership task s by the self -reported leadership role (formal, informal, and not currently in leadership) PAs were in at the time of the survey. Formal leaders (33.7%), informal leaders ( 30.2%) , and those not in leadership (36.1%) had similar levels of involvement in educating others in their practice. Additionally, PAs in each group reported serving as a mentor to other PAs at similar levels (Figure 3) . However, administrative tasks like leading quality improvem ent activities (51.8%), completing competency assessments of PAs (60.5%), and managing a budget (80 .0%) were more likely to be completed by formal leaders. PAs who were not in a leadership position were more likely to report they were currently precepting PAs (41.7%) . Interestingly, there was no specific leadership task that PAs who were in informal leadership indicated they were currently performing at a higher rate than PAs in formal leadership and /or PAs who were not in leadership. However, 3 in 10 (31.0% ; Table 6 ) PAs who repo rted su pervising or managing non -clinical staff were in informal leadership. The leadership tasks held by PAs also varied based on their work setting. A vast majority of PAs who su pervised or managed clinical staff other than PAs (59.8%) or non -clinical staff (61.5%) worked in outpatient clinics or physician offices. However, supervising or managing PAs (44.0%), hiring and firing PAs ( 43.3%), and participating in PA credentialing (45.2%) was more likely to occur in hospitals (Table 8). Figure 3. Participation in Leadership Tasks/Activities 51.6 45.4 43.9 43.6 40.7 33.7 35.5 27.8 34.7 43.4 30.2 31.5 30.5 29.7 26.1 36.1 33.1 41.7 35.6 30.6 0 10 20 30 40 50 60 Educating others in your practice (not including precepting) Serving as a mentor to other PAs Precepting PAs Helping onboard PAs Participation on a committee Percent (%) Overall Formal Leader Informal Leader Not in Leadership PAs in formal leadership roles often handled administrative duties like competency assessments (61%) and budget management (80%). PAs in Leadership: What do they do ? A report from the 2022 PA Practice Survey 7 | 1 3 © 202 3 American Academy of Physician Associates . All rights reserved. Not for distribution or reproduction. Past and Future Tasks PAs also indicate d which leadership tasks they previously held, were interested in, or were not interested in. In line with the previous tables, many PAs who had formerly performed a leadership task indicated they had previously precepted PAs (41.4%) and served as mentor to other PAs (32.7%). Administrative tasks such as supervising or managing non - clinical staff ; ensuring compliance with federal, state, and accreditation requirements; managing a budget; and serving as a union representative or steward were the tasks that were both leas t likely to be held previously and had the highest level of PAs indicating they were not interested in performing. Among the leadership tasks PAs were not currently performing, but were interested in, the highest rated were serving as a mentor to other PAs (44.9%) , helping to determine how many PAs are hired (43.5%), and helping to onboard PAs (40.6% ; Table 7 ). Overall, 81.0% of PAs indicated they were supporting efforts to onboard PAs and/or APRNs either formally or informally . Less than half (41.5%) of PAs were participating in tasks outside of the tasks they were hired to complete. However, only a quarter (24.0%) of PAs were serving as a representative for other PAs, or PAs and APRNs, to management. Almost three in four (72.9) PAs are serving as a mentor for PAs and/or APRNs. Within that group, 49.0% were informally assigned to this activity (Table 9) . In the November 2022 fielding of the PA Practice S urvey, we asked additional questions regarding the utilization of mentors within PAs’ organizational leadership pathways. Here, we found more than a fifth (21.7%) of PAs currently have a mentor who supported them in their pursuit of additional leadership opportunities. Moreover, an additional 24.3% were mentored in the past, with almost one third (31.4%) of PAs interested in being a leadership mentee in the future . Comparatively, while a quarter (24.5%) of P As were not interested in being a leadership mentor , 38.3% were interested in becoming one, 13.4% had been one in the past, and 23.9% were currently serving as leadership mentors (Table 10). Additional insights on pathways to PA leadership are presented in the third brief of this leadership series “PAs in Leadership: How do they get there?”. Conclusion PAs are currently serving in leadership roles within their workplaces, even if they do not have a formal leadership title. Moreover, there is a considerable proportion of PAs who are not currently in, but are interested in, leadership taking on additional opportunities within their employers. The most frequently cited leadership related tasks performed by PAs were often related to workplace education and mentorship. Fewer PAs reported performing more administrative leadership tasks, such as hiring and firin g of PAs , chairing a committee , and/or m anaging a budget ; those that did were more likely to be in formal leadership positions. PAs are also taking an opportunity to mentor new PA leaders through the challenges of leadership. Regardless of their professional setting, most PAs are actively seeking opportunities to become involved and engaged in their workplace. 22 % of PAs currently have a mentor who supported their path into leadership. PAs in Leadership: What do they do ? A report from the 2022 PA Practice Survey 8 | 1 3 © 202 3 American Academy of Physician Associates . All rights reserved. Not for distribution or reproduction. Data Tables Table 1 . Leadership Role , by Type Measure N Percent (%) Yes, in a formal leadership role 615 16.6 Yes, in an informal leadership role 840 22.7 Not in the past year, but I am interested in one in the future 845 22.9 Not in the past year, but I have been in one in the past 304 8.2 No, and I am not interested 1090 29.5 Total 3,694 100.0 Source: 2022 PA Practice Survey Question: Are you in a leadership role at your primary employer, either formally or informally? Table 2. Leadership Role by Career Experience Measure Formal leadership Informal leadership Interested in leadership Not in, or interested in leadership Percent (%) 0 to 1 year 0.5 1.6 9.3 3.9 2 to 4 years 8.1 18.4 35.3 20.3 5 to 9 years 20.7 24.5 28.9 22.9 10 to 14 years 22.0 16.9 13.9 15.8 15 to 19 years 18.4 14.3 4.9 12.4 20 or more years 30.4 24.3 7.7 24.7 Total (N) 615 838 841 1,391 Source: 2022 PA Practice Survey Question: What year did you graduate from your PA program? Question: Are you in a leadership role at your primary employer, either formally or informally? Table 3. Leadership Role by Primary Specialty Measure Formal leadership Informal leadership Interested in leadership Not in, or interested in leadership Percent (%) Other specialties 23.4 24.7 23.4 27.6 Primary care 22.8 24.3 20.6 22.6 Surgical subspecialties 21.1 27.8 27.8 25.4 Internal medicine subspecialties 11.7 12.2 15.0 13.1 Emergency medicine 8.8 5.3 8.9 7.3 Pediatric subspecialties 1.0 2.4 2.0 1.7 No medical specialty 11.2 3.3 2.3 2.3 Total (N) 615 838 841 1,391 Source: 2022 PA Practice Survey Question: Please indicate your primary employer type. Question: Are you in a leadership role at your primary employer, either formally or informally? PAs in Leadership: What do they do ? A report from the 2022 PA Practice Survey 9 | 1 3 © 202 3 American Academy of Physician Associates . All rights reserved. Not for distribution or reproduction. Table 4. Leadership Role by Primary Setting Measure Formal leadership Informal leadership Interested in leadership Not in, or interested in leadership Percent (%) Outpatient clinic or physician office, College clinic 44.4 55.4 54.5 57.9 Hospital 34.1 30.9 37.8 31.1 Urgent care or convenient care clinic 4.6 3.8 4.3 6.2 University (Educator) 9.4 2.5 1.0 0.7 Other 7.5 7.4 2.5 4.1 Total (N) 615 838 841 1,391 Source: 2022 PA Practice Survey Question: Please indicate your primary setting in which you practice as a PA. Question: Are you in a leadership role at your primary employer, either formally or informally? Table 5. Percent of PAs Currently Participating in Leadership Tasks, by Task Measure N Percent (%) Educating others in your practice (not including precepting) 992 51.6 Serving as a mentor to other PAs 874 45.4 Precepting PAs 845 43.9 Helping onboard PAs 839 43.6 Participation on a committee 782 40.7 Leading quality improvement activities 529 27.5 Supervising or managing clinical staff other than PAs 512 26.6 Supervising or managing non -clinical staff 454 23.6 Ensuring compliance with federal, state and accreditation requirements 436 22.7 Performance assessment of PAs 428 22.3 Competency assessment of PAs 390 20.3 Helping to determine how many PAs are hired 385 20.0 Supervising or managing PAs 352 18.3 Hiring and firing of PAs 297 15.4 Chairing a committee 290 15.1 PAs credentialing participation 241 12.5 Managing a budget 165 8.6 Serving as a union representative or steward 24 1.2 Total 1,923 100.0 Source: 2022 PA Practice Survey Question: Which of the following tasks do you currently have, or would like to have, responsibility for at your primary employer?