SESSION I JANUARY 20-22, 2011

JW MARRIOTT – WASHINGTON DC

Joint Task Force on the Future of the PA Workforce

Why a Task Force?

Impact of ACA on uninsured

Population Projections

Demand for health care services for males

Demand for health care services for females

Prevalence of chronic disease

Physician Shortages

AAMC projects a shortfall of over 90,000

physicians by 2020

How can PAs fill the gap?

Charge of the Task Force

The charge of the joint task force is to develop recommendations which can be implemented by AAPA and PAEA for the growth of the PA workforce in a manner that maintains quality and assures the profession’s maximum impact on the health of the nation through 2020.

Focus areas

  The recommendations should span the continuum of the profession from pre-professional student to the most experienced clinician.

  Address the spectrum of future opportunities and challenges for the expansion of the profession including:   Ensuring a diverse workforce   Creating the educational infrastructure necessary for Development of

quality programs   Maximizing the distribution of PAs by specialty, geography and other

attributes

Task Force Members

  Ingrid Abrahamson (SAAAPA) Yale University PA Program

  Lisa Mustone Alexander, EdD, MPH, PA-C The George Washington University

  Barbara Barzansky, PhD, MHPE (NCCPA) American Medical Association

  Pat Jennings, Dr.PH, PA-C UAB Surgical PA Program

  David M Krol, MD, MPH, FAAP Robert Wood Johnson Foundation

  Stephen A. Kudebeh, PA-C Denver Health and Hospitals

  Kathleen Klink, MD* Health Resources and Services Administration

  Maryjoan D. Ladden, PhD, RN, FAAN (alternate)* Robert Wood Johnson Foundation

  Kevin Lohenry, PhD, PA-C (PAEA) Midwestern University Glendale

  Sharon L. Luke, PA-C, MSHS (ARC-PA) University of Mount Union

  Michael McClain, MHS, MS, PA-C* Eveia Health Consulting & Management

  Paula Phelps, MHE, PA-C Idaho State University

  Perry Pugno, MD, MPH, CPE American Academy of Family Physicians

  Lance Talmage, MD Federation of State Medical Boards

  Robert L. Wooten, PA-C (AAPA) Forsyth Medical Center

Planning and Facilitation

Project Web Site

Pre-Event Activities Interviews with PA workforce experts

Perri Morgan,

PhD, PA-C Assistant Professor

Director of PA Research

James Cawley, PA-C, M.P.H

Professor and Vice Chair of the Department

of Prevention and Community Health,

Professor, Health Care Sciences at GW's School of Medicine and Health

Sciences

Roderick Hooker,

PhD, PA-C Senior

Director, The Lewin Group

Pre-Event Activities Required Reading

  Cooper, RA. New Directions for Nurse Practitioners and Physician Assistants in the Era of Physician Shortages. Academic Medicine 2007; 82(9): 827-828.

  Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. October 2010. (Brief Report and Recommendations)

  Kirsch, DG and Vernon, DJ. Confronting the Complexity of the Workforce Equation. JAMA 2008; 299(22): 2680-2682.

  Colwill JM, Cultice JM and Kruse RL. Will Generalist Physician Supply Meet Demand of an Increasing and Aging Population? Health Affairs 2008; 27(3): w232-w241.

  Bureau of Labor Statistics. Physician Assistant Report. 2010.   Miller, A, Glicken, AD. The Future of Physician Assistant Education. JPAE 2007; 18

(3): 109-116.   Guthrie D, Valachovic RW, and Jackson Brown L. The Impact of New Dental Schools

on the Dental Workforce through 2022. Journal of Dental Education 2009; 73(2): 1354-1360.

Keynote by Ed Salsberg

Ed Salsberg, Director, National

Center for Workforce Analysis,

Bureau of Health Professions at the Health Resources

and Services Administration

Predicting the Future

  Identify four variables, forces or factors that are extremely important for the PA profession but also extremely uncertain.

  For each of the four variables identify the two extreme endpoints or “wild innovations”

Innovating across the Continuum

  Four “wild innovations” were selected. Each group described their innovation in detail, how it impacted the PA profession, health care and society at large, and what obstacles had to be overcome for it to be successful.

  ACROSS THE CONTINUUM:   The pre-PA education phase   The didactic education phase   The clinical education phase   The early career PA phase   The mid- to late-career PA phase

Determining Our Own Future

  Three potential scenarios for the growth of the profession by 2020 were identified. Each group discussed the impact of this scenario and discussed how the scenario occurred, what the profession did to make it happen, what it failed to do, and the opportunities and challenges. The scenarios are:   Rapid expansion:

  300,000 practicing PAs and 18,000 graduates per year

  Status quo:   150,000 practicing PAs and 5,500 graduates per year

  Contraction:   100,000 practicing PAs and 2,500 graduates per year

Determining our future

 Each group predicted either how many PAs there SHOULD be in 2020 or how many PAs there COULD be in 2020.

 What factors, facts, trends and issues drove the prediction?

Beginning to Develop Recommendations

  Given all the pre-event materials, keynote address, and scenario planning exercises, each individual developed a list of recommendations for the PA profession that applied across the continuum of the profession (from applicant to clinician) to accomplish and addressed the key objectives of the task force charge.   To ensure a diverse workforce   To provide quality infrastructure

for PA education programs   To maximize distribution of PAs

across practice areas and geographies

Common Themes in the Draft Recommendations

Ensuring diversity

Emphasis rural and

underserved

Focus on primary care

Interprofessional collaboration

Changing the health care

system

Research on teams

Enhancing quality of PA

education

Legislative and regulatory advocacy

Building community connections

Engagement of PAs and

PA students

In addition to the four focus areas, several recommendations

addressed health care system-wide priorities.

Preliminary Recommendations

How to attract the right qualified applicants? (Pipeline and admissions)

  Engage community college advisors to suggest PA careers   Review and revise admissions requirements   Integrate educational best practice into admissions

process   Increase early exposure to the PA profession   Advocate for K-12 science education   Create rural community pipeline programs   Standardize pre-requisites   Increase PA student outreach to schools and feeder

colleges   Develop a PA career option resource   Create coordinated pre-PA clubs for feeder institutions

How to ensure a quality educational experience? (Didactic curriculum)

  Standardize pre-requisites for PA schools   Integrate service learning experiences with exposure to

marginalized populations   Create loan repayment for faculty, especially

underrepresented minorities   Increase interprofessional exposure   Create diverse classroom environment   Encourage external curricular review   Create formalized consultant bank   Increase standardized admissions bank   Develop PA program quality metrics and best practices

How to train in the right clinical settings? (Clinical curriculum)

  Make rural and/or underserved rotations a “should” in accreditation standards

  Develop initiative for preceptor recruitment, retention, recognition (incentives)

  Create an effective clinical year orientation for students   Use technology to connect remote preceptor locations (for Grand

Rounds, case discussions, etc.)   Seek funding for interprofessional education pilots   Establish a centralized clinical resource clearinghouse   Create community partnerships for recruitment, clinical training,

and deployment   Develop simulation and alternate clinical teaching strategies and

assessment tools   Coordinate clinical training resources among the health professions

How to place PAs in the right settings post-graduation? (Clinical practice distribution by specialty & geography)

  Identify and promote the best practice models using teams of clinicians

  Engage clinical preceptors (esp. PAs) more thoroughly in the educational process through incentives and mentoring

  Ensure perfect PA practice laws in each state to decrease obstacles to practice

  Support full funding for the National Health Care Workforce Commission

  Create mechanisms to ease re-entry into the profession by PAs who have been away from clinical practice

  Support investment in telehealth infrastructure and policy to innovate disease management

  Advocate for change reimbursement structure to support team-based care and non-visit care

  Increase dialogue between PAs and nursing, specifically, and PAs and physicians generally.

Next Steps

  Produce a report summarizing the first meeting   Collate and refine draft recommendations   Share activities with the Boards of Directors for

AAPA and PAEA   Plan next meeting – April 2011   Collect additional information   Finalize recommendations   Present a report to the Boards of Directors for AAPA

and PAEA

Reflections from Board members

Robert Wooten, AAPA

Kevin Lohenry, PAEA

Small Group Exercise Prioritization of Recommendations

At your tables, each group should review the potential recommendations of the Joint Task Force on the Future of the PA Workforce.

Use the hardcopy or the web site: http://www.surveymonkey.com/s/LGJ3NYF

For each recommendation your team should score the recommendation in each of three strategic areas - importance, feasibility and cost - as described on the following slide.

In addition, discuss the criteria you used to determine the importance, feasibility and cost for each recommendation.

Small Group Exercise Prioritization of Recommendations

Importance - Is the recommendation a critical part of our organizations' future success in responsibly growing the PA workforce?

Feasibility - Is the recommendation something in which our organizations have the current capacity to implement? Do we have control over its implementation? Is it easy or hard to do? Do not consider financial constraints, just practicality.

Cost - Is the recommendation expensive or inexpensive to implement in terms of our organizations' budgets? Can we do it cheaply or will it require long term investments? Think only about the financial impact, not the value gained.

Small Group Exercise Review

  http://www.surveymonkey.com/s/LGJ3NYF

 Score each recommendation by importance, feasibility and cost

 Discuss the criteria you used (evidence, bias, experience, values, etc)

 Prepare to share it with the entire group

Report out and discussion of results

Questions?