Silos(fiefdoms)in Administrative Medicine: An Executive Glass Ceiling for Physician Associates

In recent years, the Physician Associate community [PAs] has made significant professional strides. There are over 160,000 practicing PAs in the US healthcare system today. Their role and scope of practice continues to evolve. The demand for PAs remains high, and for industry observers, a trend that is expected to continue.

            While PAs have been largely accepted and recognized in the medical community, it has not been without growing pains during our evolution as a profession. The concept and acceptance of the non-physician provider role as an inter-professional team member of the healthcare delivery model as promulgated by the Institute of Medicine in 2003 has not been readily embraced by some sectors and/or other inter-related stakeholders of the Healthcare industry. Luckily, albeit somewhat slowly, we’re heading in the right direction as many will attest.

             Unfortunately, there are still “fiefdoms” or “silos” or better yet an “Executive Glass Ceiling” for PAs in Executive Leadership positions and/or Boardroom positions. Sadly, in the world of administrative medicine, we [PAs] still remain unrecognized and undervalued as solid potential contributors, either in the boardroom or in hospital executive committees.

Why is the industry so Myopic?

If PAs have come a long way, why are we so underrepresented in administrative medicine leadership positions? Why are we still nowhere we deserve to be? These are the 2 main questions that remain unanswered when one looks at this vexing problem more closely.

Potential Reason(s)as to why the industry is so myopic?

As a seasoned PA myself, I’m all too familiar with the long battles that we have faced throughout the last 35 years in our pursuit of professional recognition alongside professional respectability in a very well-known fragmented industry.

While our care, expertise, and contributions to this industry have been second to none, I do believe our underrepresentation stems from a few industry root barriers which I will try to objectively bring to light by analyzing while discussing them respectively in no particular order of importance. Here they are:

• A Caste system in place: Professional stratification or segregation is commonly seen and found in corporate America. This unconscious subtle mindset and societal reality can account for an industry remaining to a large extent non-inclusive of other competent healthcare professionals aspiring to be part of this leadership group throughout our healthcare organizations.

• The “Assistant stigmatization": I suppose being in the shadow of our professional colleagues (physicians) has made many administrators question or second-guess our worth or even underappreciate our skill set for that matter. Of note, according to a 2011 American Hospital Association survey, nurses comprised 6 percent of the hospital board members. This was in contrast to physicians, who represented 20 percent of hospital boards. We are not remotely close. Some healthcare organization executive administrators are starting to realize that the smooth running of complex successful healthcare organizations not only demands very high levels of understanding and cooperation between professional groups with different expectations and backgrounds/training, etc. but also the challenge to debunk openly “professional organizational turfism” behavior.

         While the current picture remains a mixed one, and/or elusive one, I/we hope that our profession continues being recognized in these rapidly changing business environments for our past contributions, but more so for our forged collaborative commitment to all stakeholders during the past half-century.

          It should be clearer, that the old adage of “business as usual” is no longer relevant; in fact, we should instead consider replacing it with “we’re all in this together”.