PAs in Leadership: Dr. Brooke Schweitzer

From the OR to the C-Suite: Dr. Brooke Schweitzer on Advanced Practice Leadership in Healthcare

On this episode of the Building Bridges podcast, host Cody Sasek interviews Dr. Brooke Schweitzer, a plastic and reconstructive surgery physician assistant and Executive Director of Advanced Practice Providers at University of Chicago Medicine. She was appointed to this inaugural role amid rapid APP growth from about 200 pre-COVID to over 600 current. Schweitzer describes overseeing PAs, NPs, CNSs, CRNAs, and nurse midwives across multiple sites, and shares how she discovered the PA profession after shadowing in surgery. 

She recounts unexpectedly stepping into interim hospital leadership at a critical access hospital, prompting her to pursue a doctorate and business residency to bridge clinical and administrative “languages.” She emphasizes saying yes to opportunities, listening, transparency, servant leadership, stakeholder alignment in matrixed organizations, and measuring value through key metrics like length of stay and readmissions as healthcare shifts toward value-based care, while advocating for stronger APP representation and leadership pathways.

Transcript

SPEAKER_01 0:01

Hello, and welcome to this episode of the Building Bridges Podcast. I'm Cody Sheszek, and today we'll explore the leadership journey of a prominent physician assistant, highlighting their path, challenges faced along the way, their lessons learned, and their perspectives on leadership within the healthcare system. Our guest today is Dr. Brooke Sweitzer. She's a physician assistant, practices in plastic and reconstructive surgery, and also serves in an administrative role at the University of Chicago Medicine as their executive director of advanced practice providers. Welcome, Dr. Schweitzer. Brooke, thanks for joining us today.

SPEAKER_00 0:34

Absolutely.

SPEAKER_01 0:34

Great. So we can start for our listeners giving a snapshot of what your current job duties entail.

SPEAKER_00 0:40

I'm executive director here for UChicago Medicine, and this was an inaugural role. They took a conscious effort to invest in APP leadership. They saw a mere exponential rise in their APPs since right before COVID, where they had about 200, I would estimate, until now, where we have well over 600. With that comes lots of opportunity for growth and setting the right pathway for how to implement APPs into their care teams. Seeing nationally that APPs are 40% of the provider workforce, we certainly need some representation to support and recognize these important professionals for the future of medicine. So that's my role now. It's based in Chicago on the south side here in Hyde Park. Although we have a multitude of sites of clinics, and then we also have a community-based hospital in Harvey, Illinois, as well as a new micro hospital in Crown Point, Indiana.

SPEAKER_01 1:36

I'm assuming that your work crosses over with both PA and nurse practitioner colleagues, or is your portfolio of providers larger than that?

SPEAKER_00 1:43

Nope, it's for all APPs. We use that our umbrella term. I think some hospitals define it differently, but for us, we consider PAs, nurse practitioners, clinical nurse specialists that are working in a provider capacity, CRNAs and nurse midwives as part of our portfolio of APPs.

SPEAKER_01 2:01

One of the things that we're really interested about in so many of these conversations on the podcast is the importance of PA leadership in healthcare and how PAs can bring a unique perspective and knowledge. I feel like that's a growing presence, having that PA voice in those leadership levels approaching the C-suite and even in large healthcare organizations like yours. So looking back a little bit, becoming a PA, what was the draw for you as you looked at all of the career options that were out there for?

SPEAKER_00 2:30

To be honest, PA wasn't my first choice. I really didn't even know about the PA profession. I thought that I wanted to go into medicine and I really researched going to med school, and anesthesiology was the top of my list. I remember in high school we had to write a big paper about what we wanted to do for our future, and I wrote about being an anesthesiologist. Through that process, I did some shadowing and really just wanted to make sure that going into pre-med was right for me for college. So I shadowed an anesthesiologist. And during that time, I thought, wow, this is not for me. I felt that it was a little bit boring not to put down what anesthesiologists do, but the anesthesiologist that I was shadowing was just phenomenal, where he almost had everything on autopilot. They were working in a surgical center. During the time that I was shadowing him, I thought maybe being a surgeon is more what I want because I was talking back and forth with the surgeon, learning more about the case. It turns out that it was a neurosurgery PA that was closing, working with the neurosurgeon who was working in a few different rooms. And my mind just kind of exploded. I had no idea that PAs could work in surgery. I really only thought that, or I guess my only connection with them was through family medicine, where the provider that I was seeing, I originally thought was a physician, but it turns out it was a PA. And I just thought she was incredible. So after learning both of those data pieces, I thought maybe PA is the way for me to go. I had to pay for my own college and knew that it was going to be a long and expensive ride. And I thought maybe PA is the way to go where I can have the same amount of impact and have a lot of career flexibility that perhaps physicians don't have. And so that's the pathway that I took. And being in the career for a few decades now, it was definitely the right choice.

SPEAKER_01 4:10

That's awesome. Thinking about how you've been both actively engaged in clinical practice and then in your role now, which is clearly still related to clinical practice. Did you always see yourself moving into a clinically adjunct sort of role, something that embraced both your clinical background but also your other skills and interests?

SPEAKER_00 4:30

It kind of just happened by happenstance. It really wasn't the plan, but I feel like I kept raising my hand for projects that came up or would always insert my feedback if I thought things could be more efficient or I found a different way to do something. But early on in my career, an opportunity just fell on my lap. I'll be honest, I was wildly, wildly unqualified for this role. But when I started practicing at a small critical access hospital in the middle of nowhere where the closest level one trauma center was five hours away, we were really kind of like the mainstay for this community. It was a medical desert. So it was really important to keep the hospital open. The CEO and the CFO both left the same month for promotions at a larger hospital states away. And they tapped myself and another PA colleague to fill in in an interim capacity to keep the hospital afloat. I had zero idea about hospital leadership. I barely even knew how to be a practicing PA. But I was like, sure, I'll step in, whatever we need to do to keep this hospital open so that we can accept patients and figure out a pathway forward. Eventually, I'm sure they'll hire new executives. And it was a quick and dirty path to learn everything about hospital leadership. Through that pathway, I learned that what administrators talk about and the things that they're worried about are vastly different than how we were taught as providers to think about patient care. In PA school and medical school and nursing school, you are taught the medical language, and that's what you speak. That language is very different than the business side of medicine. I thought, you know, I really think that I need to delve more into this to understand the business side more because I didn't know what a pro forma was or money or margin or how to read a hospital cost report. And so I went back to school and I got my doctorate and I did a business residency and healthcare administration. Now I feel like my forte is really that pathway or the intersection of the clinical knowledge from my work as a PA, but also paired with the business knowledge and how I can speak the language on behalf of PAs, but also play favor to the things that the administrators are worried about. With that came a host of different promotions from there on. I think it was because I said yes to an opportunity that came my way.

SPEAKER_01 6:42

As you were talking, I was thinking about how that experience sort of mirrors a PA student's experience or a PA in first time in practice or in a new specialty where they kind of know, but there are so many questions out there that it can be kind of overwhelming and certainly can feel like an imposter. So knowing what you know now, what are is there any advice that or anything you learned in going through that experience, stepping into a really important leadership role and maybe feeling like I can do this. I'm just not sure how that's all gonna play out. Yeah, but any lessons learned from that that you know that you're kind of on the other side and you're fluent in the language, you're doing the thing day in and day out?

SPEAKER_00 7:20

I think be involved and stay up to date with what's going on because when an opportunity comes your way, you want to be prepared for it. While you may never feel completely prepared, you'll at least have some insight and you'll know who to go to or who to ask questions to. You know, when opportunity comes your way, you just gotta say yes. I think that in many of our careers, no one is perfect. Everybody has to learn the pathway forward. Part of experiencing guessing and checking, guessing and learning, that's how we're all learning. But you have to start from some sort of foundation saying yes, finding out who your allies are, finding out who your peers are, making friends in other disciplines. You know, together you will figure it out. The weight of the world isn't always on your shoulders, and you can do it together, and that's usually the best way to do it. And it's also better to learn as you go, to build those different coalitions of people to help you along your way. First start is, you know, stay in tune, stay up to date, and say yes when those opportunities come your way. You may feel that imposter syndrome, but gosh, doesn't everybody when they start out?

SPEAKER_01 8:20

It just strikes me that as PAs, we always think about we're flexible, we can step in, we fill gaps in care. And in a different context, you're really doing the same thing. Was there anything that you learned once you got more familiar with that administrative side of the coin that impacted how you thought about the way that you provided care?

SPEAKER_00 8:37

I think that I had to learn to articulate what the benefit of PA leadership was. I understand the operations from beginning to end, and I understand all of the intricacies of how that patient schedules an appointment with us online or comes in through our front door, or how they get transferred from one floor to another, or how they get discharged from the hospital. I think that PAs play an important role throughout the entire continuum of care that sometimes is not seen by physician leaders or nursing leaders because we are able to work in all of those different sectors. I think that articulating how we can be beneficial and how we can step up and really create value was important. But I think more importantly, I had to prove myself that just because I don't have the fancy letters of MD behind my name doesn't mean that I can't be a leader and doesn't mean that I can't help patients more than one at a time. Even though my role as a PA I was seeing patients one at a time, I had to figure out how to utilize what I knew in those patient encounters to help patients more on a broader scale and figure out what those inefficiencies were and figure out what the opportunities were to leverage my actual patient care into a real leadership position where I wasn't having those touch points every single day.

SPEAKER_01 9:59

I imagine you're spending even the sort of simple, straightforward problems like we need to improve throughput in the ER, are these sort of complex systemic issues or systems issues? It's an interesting perspective that you bring thinking through those sorts of things and how, as you mentioned, you're not just impacting the individual patient encounter, but you're thinking beyond that. Do you feel like that was a different skill set for you in thinking through the kind of strategic big picture, kind of micro and macro at the same time?

SPEAKER_00 10:30

When we're in PA school, we learn about what's the differential diagnosis and what are the potential complications of X, Y, or Z medicine. But you're not really thinking of when I prescribe these home infusion antibiotics when they get discharged from the hospital, how are they actually going to get them? And what company is gonna come to do that? How do I make sure that a home health nurse comes to actually see them? When you work in administration, you have to think about those touch points because even when the patient leaves your site or leaves your level of care, you don't want them to come back with a complication because we failed to support them during that transitional care time. And so as a clinician, I could see that very clear as day, but that's maybe not something that an administrator would think about because they're not having to see those patients or see those complications. We also learn as PAs to think a little bit differently, where we can think outside of number of patients and RDUs and billing, because we're frequently asked to do things that are not only at the level of a provider, but sometimes you have to help out with scheduling, and sometimes you have to help out with, you know, care coordination. And while that isn't the bulk of our job, we certainly have other care team members, we understand how those pieces interrelate and how also our role in our patient care translates to better care for other areas that we might not always touch.

SPEAKER_01 11:48

So the to kind of thread through all this is the growth opportunities and the way you've capitalized on that. Specifically in leadership, what do you think has been the really effective ways you've been able to develop, build on obviously the skills and knowledge and all the things that you bring to the table, but to continually grow in a leadership role and perspective? How do you think about that or what's been successful or helpful or not, maybe in your own leadership journey?

SPEAKER_00 12:15

I think knowing the metrics is probably the most important thing. And when I started as a clinically practicing PA, that wasn't even something that I thought about at all. I was just thinking about how can I do the most good for my patients, how do I make sure that I do the right thing, how do I make sure that I'm considering all of the different zebras that could potentially be happening to this patient. I wasn't thinking about readmission scores. I wasn't thinking about how many Medicare annual wellness visits I was doing. I wasn't thinking about length of stay in the hospital. But those are the things that matter to the hospital, to the Center for Medicaid and Medicare Services, who kind of dictates what we can and cannot do. And also is important for the hospital board. Every hospital has a board that oversees them and they hold the clinicians and leadership responsible for certain metrics. Now more than ever, as we're transitioning from fee-based care where we're seeing one patient at a time, to really transition to value-based care where we are compensating our providers in our hospitals based on the outcomes, we have to double down on those metrics. So thinking about what's important to your leadership and owning it, length of stay, readmissions. If we're not making the money, then we don't have a mission to help patients. And so even though sometimes it's not fun to think in the money terms or think in the RVU terms, that's how we're being judged and that's how we're being evaluated. That's the current system that we have. And so we have to understand and own our metrics. And for PAs, we can go into like a plethora of different niches in the quality world, in the safety world, in risk. There are just a plethora of different opportunities for PAs to get involved that I think haven't even been explored that much. Can PAs be chief compliance officers? Can PAs be chief quality officers? I think the answer is yes. We have a lot of good knowledge that we can impart towards that. But that's still a pathway that is yet to be trailblazed by part of our profession.

SPEAKER_01 14:07

I think it's so interesting. Even your own experience with the bigger health system, standing up your shop and bringing a PA in to lead that. It seems like there are a lot of health systems doing the same thing that are at various stages of that. It just really seems like, from my perspective, a really interesting time to be a PA because of all of those things. Where 10 years ago, I guess I wouldn't have thought it was like either you were a clinically practiced PA or you were in education. I don't know about you, but I feel like we have such a strong identity as a PA at the bedside, doing the clinical work that we do. But it's so true. And you mentioned earlier that, you know, PAs have a tremendous perspective and skills. And so I think it's just such an interesting time. And it's one of the, I think one of the themes of this podcast is what does that future look like? How do you see PA leadership evolving over maybe the next five or 10 years? Does that become you mentioned some of the possible avenues for PAs to contribute on a large scale? Any thoughts about what some of those areas are?

SPEAKER_00 15:09

Oh yeah. I think you mentioned, you know, just a few minutes ago that like now is an evolving time, a changing time in healthcare. And now, more than ever, do we have the opportunity to become involved in in leadership? I I mentioned this earlier, but I think a really important statistic to think about is that 40% of our entire nation of providers are APPs, PAs and nurse practitioners. And there's gonna come a time in the upcoming couple years where we're gonna be approaching 50%. I think that this statistic is really powerful because it's making us reevaluate, okay, well, how how do we set up our teams and how do we set up our hospitals and what can we do to support these important providers? We're not going away, we're continuing to multiply because PAs are the key to access in medicine. And as we have a shorter and a shorter list of physicians where we don't have some of the super subspecialties, or maybe there's a trend where physicians are going more into the super sub-specialties rather than primary care, is there an opportunity for us to think about how we treat patients and maybe joining along with our physicians and making it more of a team-based leadership rather than kind of physician-centric? I think that there's enough patients to go around and we should be utilizing our physicians to their fullest capacity, whether that's in the procedural areas, in surgery, in some of those really complex sub-specialties. How do we utilize PAs to fill those gaps? We certainly can see patients for their diabetes, for their hypotension. We can see them for their preoperative visits, for their surgical clearance visits. There are so many ways to feather in APPs for the betterment of patients. And we certainly know that with the changing times, there's certainly enough patients to go around. And as healthcare changes, we know that people that hadn't had care before are now seeking it. We need to figure out how we layer in PAs to that. I was recently involved in a task force with the American Hospital Association about how to set up APP leadership in hospitals. Because it's not standard and it is something relatively new. And because we have so many PAs and nurse practitioners, we really need to figure out a way to represent and advocate and support them. PAs and nurse practitioners, speaking of them together, we don't really fit into the nursing bucket because we're not practicing as nurses. Even though nurse practitioners may start out as nurses, we're not functioning in that capacity. And that's very different from the provider capacity, but we're not physicians either. And so we need our own pathway to figure out how we can do the most good, how we can represent not only our profession, but how we figure out how to implement APPs appropriately into our care team models alongside our nursing colleagues, alongside our physician colleagues, so that we can be efficient with care.

SPEAKER_01 17:58

Yeah, I think about my first job, which was in orthopedic. So we were all the hospitals all over the KC area. I think I had 35 different privileges at some point, maybe not quite that many, but it felt like it when it came time to re-credential. And it was so interesting that some of those you, as part of the medical staff, you fell into, you know, kind of the medical staff with physicians, and then in others, it was more nursing-centric. And it always felt like it didn't serve anyone very well, frankly. Clearly, there are unique needs and things that that PAs have where it likely doesn't fit with.

SPEAKER_00 18:31

That's an interesting point you bring up about the medical staff and even credentialing, because our hospital bylaws are set up to only look at it from a physician lens. Here in Illinois, there's a state law that says that PAs and nurse practitioners are not defined as part of the medical staff, meaning that we don't have voting capability and we're typically not invited to medical executive committees where decisions are being made about how to run the hospital. But that's something that we also have to think about because we really need to learn from our nursing colleagues who have set up great pathways for their professional development and leadership, and learn from how they've built that. They certainly have been around a lot longer than we have and have a lot of research on their profession. I think that that's an area that is a big gap for PAs. Having leadership is what opens the door to get invited to those meetings and to even ask, hey, I think we need some representation there. I see that this hospital has a large number of PAs and nurse practitioners. Do you think that you want an APP voice sitting at the committee, even if we don't have a voting ticket?

SPEAKER_01 19:30

Yeah, I think that's so true. And when you look more broadly at battles with the AMA or individual state advocacy efforts towards optimal team practice, like those sorts of things all require people to get engaged. And I remember that I think this was still when I was a student, one of the more seasoned faculty. I remember a comment about that, you know, it's easy to not think about advocacy because for a certain generation, I guess my age and younger, like we've kind of had it pretty good. We haven't had to fight a lot of battles, but there are important ones out there for the at least in my perspective, for the next five, 10, 20 years that we need to be engaged in and part of the solution rather than watching from the periphery. Absolutely. That's my edit my editorial point of the episode.

SPEAKER_00 20:13

But we have had it pretty good. The path was paved for us, but there's still a long pathway to go. And if we don't speak up, somebody will speak up for us. So it's up to us to create the solution before the solution is made for us.

SPEAKER_01 20:25

Yeah, no doubt. So we'll move to a little philosophical segment here. Just think about how you think about leadership and particularly the interpersonal management of I imagine when your first leadership role is really a a young professional, that was probably a challenging piece of it, managing the operations of it with the organization's people.

SPEAKER_00 20:49

Yeah, I think that an undervalued aspect of leadership is listening. Not about it's about you listening to your teams, to those around you, even when you have a different perspective. Just sitting down to listen, being heard is an important point. I like to use a couple of catchphrases when I speak about leadership. It's not just the power and authority, it's that you really have to make the hard decisions. Sometimes you're making decisions with incomplete data. And not everybody's gonna like those decisions. But if we don't make the hard decisions, we won't have a clear path forward. I always like to say clear is kind. I think that was coined by Brene Brown. If you can articulate the equity and the reasoning and the logic behind your decisions, even those who don't like it may understand and help them to come to a similar conclusion. Just listening and having some empathy is really an important aspect of leadership. I think another thing is radical transparency. That's definitely something that feels missing in today's landscape and nearly every hospital that I've worked at. Sometimes it is hard to share all of the different data pieces that are going on, but being as transparent as possible about here's why we're doing this, and here's why we're asking you to work differently, and here's why we're asking you to cover this clinic on Mondays, or cover a different clinic on Tuesdays. Is the why behind it and how every decision ultimately is rooted in the patient's best interest. I also think that servant leadership as a clinical leader is very important. I still practice clinically, but sure it's less than the rest of our clinically practicing API. I find it very important to articulate when I'm asking people to work differently or asking them to do more, that I'm not asking them anything that I am not held accountable for myself. Because ultimately I'm still accountable to patients. I'm still practicing, I still hold privileges, and I understand what it's like and the responsibility that that holds. I think servant leadership is so important for PAs and all clinical leaders to understand the gravity of making tough decisions for patients.

SPEAKER_01 22:46

So I'm sure one of the challenges is that in an administrative leadership role in a healthcare organization, you certainly have people above you and people you report to and people who report to you. How do you, across interdisciplinary teams, or there may be power differentials, you know, across professional silos? Somebody called them cylinders of excellence. And now every time I hear silos, I think of that. Do you have how do you go about just appreciating those and making sense of it and then using that, incorporating that in the decisions you're making, how you're communicating with people, all those things?

SPEAKER_00 23:17

I feel like this is the crux of being a PA leader, is that there are so many different competing interests. We already talked about the nurses and the physicians, but we also didn't talk about the administration or maybe even different hiring entities or the medical group versus the medical staff versus our teaching universities or academics or faculty. GPs really fall right in the middle of this where everybody feels like they have a little domain over how we practice. It is incredibly important to include all stakeholders to over-communicate rather than undercommunicate and really share the strategy and what you're doing so that you can get each one of their buy-ins for whatever project that you're doing. If you don't, it can torpedo what you're doing in a heartbeat. I think it's really important for APPs to understand the entire system, to understand the system space thinking of what goes into APP leadership, making decisions about APPs, and figuring out how to leverage those for whatever your project may be, but ultimately for the betterment of patients. I think every job posting that I have read about any sort of APP leadership, from lead to manager, talks about being in a highly matrixed organization. The image that pops in my mind is just like multiple strings attached, just like a spider web. You're in the middle of it trying to figure out who to go to for what reason. Sometimes it might be the nursing leadership, and other times it might be physicians, and other times it might be the faculty, and other times it might be the medical staff. So figuring out the landscape of okay, what are the dynamics? Like who does this leader have reporting to them and what things fall under them? Who's in charge of the medical staff? Who is in charge of the privilege office? Who runs the credentials and privileges meeting? Understanding each one of those players is absolutely necessary to getting anything done. It feels like there's so many pieces that are competing for your interest, and you have to make sure to settle up with each of them before you can even do the simplest of thing, even like sending out an email. You have to get multiple layers of approval for that.

SPEAKER_01 25:18

As you were talking about the image that popped into my mind for whatever reason was we have to have at least one pop culture moment is Charlie on it's sunny, and he has the all the pictures on the wall and the strings connecting all of the things and understanding how it all comes together that you articulate that well. So I imagine we have lots of listeners who may be young professionals thinking, like, I think I'd like to engage in the way that you've been describing. What would you describe as a typical day for you in your administrative role? Now, I appreciate that like I don't know, they're all different, maybe the the best answer. But what sort of things are you doing as a PA leader?

SPEAKER_00 25:58

I think first and foremost, I am meeting with my teams. Even though I am not clinically practicing every single day, I find it really important to do leadership rounds where I'm just walking through the clinic or walking through the hospital, just saying hi, meeting people where they are. I think that that's so important. And I feel like it is a thing that's sometimes missed by some of our other leadership that is not in the clinical realm because we really need to stay grounded in that. I am not just some kind of you know person perched up in my desk, clickety-clacking on my computer. I want to make sure that I'm still connected with the people who are doing the important work. And so that's part of it, but also meeting with my teams. Sometimes it'll be a meeting with the ortho APP leadership, talking about, hey, they need new privileges for this new clinic that they're opening, and how do we make sure that that's updated on the clinic form? Or the next hour may be our strategic workforce planning committee that evaluates all position requests that come in and evaluating, okay, we have a request for a new MICU team. We need to understand how many beds they're covering, what are the success metrics, what is the performa show? Do we have the budget for this? How does it fit in with the current residents? And then the next meeting may be hey, we need to do a market analysis of our APP compensation and making sure that we're recognizing the clinical work that each one of our APPs is doing. It is a lot of meetings and projects, and it spans the entire landscape of compliance and regulation and safety and strategy and professional development, compensation, anything and everything that touches an APP. I want to make sure that we have representation so that we can support and advocate each of our teams in that. So it is a little bit different every single day. I practice in plastic and reconstructive surgery and like to kind of use my skills as a scalpel jockey every once in a while. I love being back in the OR, but majority of my time is administrative. Meetings and emails is the name of the game, but we're slowly advancing the APP practice here.

SPEAKER_01 27:52

One of the things about one of the things that's I think so interesting about leadership often is that there's sort of an expectation of perfection in navigating everything, but that's an impossibility, right? How do you how do you work? So, like, and maybe this is a culture question, but how do you develop your team, which is you know large in number and broad, right? Across disciplines and locations and all of that, so that you have this sort of culture where there's presumed good intent and you're able to navigate those challenging situations, as you mentioned before, like you're probably not gonna make everybody happy. And the old if you're trying to make everybody happy, you probably make nobody happy, sort of a thing. How do you navigate that? Knowing that like at any given point in time, somebody's gonna be saying, What is going on with this? Somebody loves it, somebody hates it. How do you navigate that? That's gonna be part of the game often, even for the best intention, highest quality leaders.

SPEAKER_00 28:45

I always like to joke with my leaders when I'm dealing with one fire at a time that like if you're a leader and everybody likes you, then maybe you're not such a great leader because I think that it is foundational to have to make hard decisions. And of course, there's always two sides to kind of every decision that you make. The most important thing, especially as you're learning, is to make data-guided decisions. It's not my feelings, it's not your feelings, it's that we gathered as much data as possible, we figured out what the benchmarks are, we asked what our competitors are doing, and we are figuring out a way to make the most equitable decision within the guides that we have. And sometimes you do have to make decisions where you have incomplete data, and I think that that's the hardest part of being a leader. And many times for APPs, we fall into that realm because a lot of decisions are based on metrics that are outside of our control, especially RVUs. The RVU system was built for physicians and retrofitting PAs and nurse practitioners into it doesn't always make sense. And so we have to figure out the way to show the value that doesn't show up on the hospital cost report in dollars and cents. And so is that how many patient touches we have when we can query number notes as a proxy, or is it how many times we first assist in the OR, or is it how many event notes that we wrote? We have to figure out the metric to really show the value. You know, what gets measured gets resourced, and so we have to be able to speak to that. And if you can't measure it, you also can't manage it. So it's important to figure out what are the goals of your bosses and your boss's bosses, and how do you play into that with the knowledge and the value that you have of your APP teams to advance those numbers? Length of stay, readmissions are the two that come up on the top of my head. There's always how many patients are we seeing per day? Are we utilizing our existing space and resources and nursing staff? So figuring out those metrics that are important to your boss and your boss's boss and what projects they're working on, and figuring out how APPs can fit into that.

SPEAKER_01 30:44

That's awesome. So that group of aspiring leaders that I mentioned before, if you had a piece of advice for them, maybe how to get started or how to be successful, imagining that there are so many lessons you learn along the way. I imagine it takes a bit of a humble approach, or if you don't have a humble approach, you're humbled every once in a while. If I were, I think this is a would be a really unique way to contribute. What advice would you have for them?

SPEAKER_00 31:06

I think that kind of just keeping your eye peeled for what really sparks your interest. I think that as PAs, one thing that our profession doesn't have is a clear route for promotion. If you're a physician in an academic medical center, you start out as an instructor or assistant professor and then you move on to associate professor and full professor. So the the path forward is very clear and there's certain guidelines for that. But as a PA, you become a clinically practicing PA. There is no next level of being a senior PA or an executive PA. It's all about really carving your own pathway for that. So I think it's important to figure out like where your niche is and to find where the gaps are. For example, when I was practicing earlier in my career, I got to the point where I felt really confident in my specialty, where you get to a point where it's almost like you plateau, like I am never going to be the plastic surgeon, nor do I want to be, but I feel like I know almost I can anticipate all of the questions before the patient even asks them. And I almost have my monologue for every kind of question that arises because I know all the different avenues where it can go and I know all the possible solutions within my specialty. And that's great if you get to that point of clinical knowledge where you are the content expert. But once you've reached that, where else do you go? And so when I was to that point a few years into my career, I found out that I got involved in a safety report. And I had never gotten one before, but I was involved in a case that was written up in the OR that was like a takeback. I was like, oh, this is interesting. I had never gotten this report before. I chased down that rabbit hole a little bit and learned that there were actually no PAs or nurse practitioners at all who ever were included in safety intelligence reporting. How do we set up that pathway to make sure that we're represented when somebody does submit a safety intelligence report and who reviews them and what's the pathway for reviewing them? After I tracked down that pathway, then I learned what a root cause analysis was, an RCA. I had never ever heard that before. But it turns out that if it is something that arises to the level of a certain threshold that a root cause analysis and meeting has to happen for every single safety intelligence report. This is to prevent wrong site surgery or surgery on the wrong patient or retain foreign objects. But sometimes they do them for repeated safety intelligence reports where there's a kind of a track record of the same thing happening. And so slowly I got involved in the safety intelligence reports and then they put me on the committee for the root cause analysis. What do you know? I'm slowly in my pathway of rising through the leadership of patient safety. I didn't have any title. I I wasn't really sure where it was going, but I kept showing up to the committee meetings and I kept being curious and really carved a pathway for myself there. We did the same thing in kind of the quality world where we were tracking kind of the quality metrics. And that actually led to PAs being promoted into associate quality officers for each of the departments at the hospital that I was in. So I'm super proud of that, but it really didn't happen without people that supported me. And it started with just asking questions and raising my hand when I saw opportunity. I think that you have to figure out what's important, what's interesting to you. Is it patient safety? Is it quality? Is it compliance? Find some sort of project to work on and dig deep into it and figure out how you can trailblaze your own path.

SPEAKER_01 34:23

That's awesome. What a great example of living the sort of what you started with was like, I just started saying yes to things and now here I am. I think that's just such a great example for PAs. And I think one of the, this is a whole different, like a whole different podcast, but not just episode. But when you look at provider wellness, provider satisfaction, if you quadruple aim it, the I think in some ways this could be a cure for people who feel like or have that moral injury from not having a role in how things work or how things go, and maybe can aid in some of that frustration if we're trying to engage in solutions.

SPEAKER_00 34:56

So I guess that comes out in the provider engagement scores because when people are feeling burnt out, it's sometimes because they don't feel valued, they don't feel like they have ownership or jurisdiction over what they're doing. If we ensure that PAs are working at the full capacity, top of their license, top of their skills, um, you almost want to double down to cure the burnout. It's it's working more and figuring out that area that really gives you spark that cures that burnout. We see the provider engagement scores when APPs are really working at the full extent of their scope. They're not just extenders, they're not just notewriters, they're not just order entry personnel, higher engagement. And we know that higher engagement leads to better patient outcomes. Because when you feel safe at your job, when you feel valued, when you feel ownership, when you feel like you're really a part of the fabric of that institution of making the patient better, we know that that translates into better communication with patients and ultimately better patient outcomes. So every single little piece of that translates into something good for patients.

SPEAKER_01 35:54

What a great example of how the work you're doing and PA leaders across the country, both informal but really important leadership opportunities into more formal roles like yours, how much of an important difference that makes for our colleagues, for our patients, everyone. I really appreciate your skills and what you're doing. Appreciate you spending some time today sharing your experience and insights with our listeners. We thank you for your time and look forward to our listeners being able to learn from you. Thanks so much.