As the PA profession marks its 50th birthday, there are several ways to take measure of its resounding success. First and foremost is the sheer number of licensed PAs currently practicing in the U.S, which is rapidly approaching 110,000. A recent AAPA survey indicates that that this number will increase 38 percent by the year 2022, with some 8,900 new PA graduates entering the workforce each year along the way. Additionally, the survey finds that 90 percent of U.S. hospitals currently employ PAs, with an even larger percentage planning to “maintain or accelerate PA hiring” in the year to come. And of course, PA training programs are growing both in size and number in educational settings across the country in response to this demand. At last count, there are 218 PA programs currently up and running in the U.S., with over 40 more waiting to come on line.
Another indicator of the success of the PA profession is the increasing number of PAs who are assuming administrative and leadership roles in hospitals, clinics and healthcare facilities across the country. Though the number of leadership positions held by PAs is growing at a slower rate than the overall trends for PAs working as clinicians— “only 15 percent of survey respondents indicated that PAs at their [hospital] facilities are in management positions, such as department chair or committee member,” reports the AAPA— it is growing steadily nevertheless.
Who are these PA leaders? What is the range of administrative roles that they occupy? What led them to pursue positions of leadership? What resistance have they met along the way? And what might those PAs who are considering taking on leadership roles in their clinics, hospitals and workplaces learn from these pioneers? We took these questions recently to three PA leaders, all graduates of MEDEX Northwest and all “firsts” in holding their administrative positions as PAs.
Ed Lopez, PA-C, C.P.M.M. (MHA)
A graduate of MEDEX Northwest’s Seattle Class 15 of 1983, Ed Lopez recently retired as Founder and Facility Medical Director of Franciscan Inpatient Hospital Medicine Service at St. Elizabeth Hospital in Enumclaw, WA. He also held the title of Associate Medical Director of Enumclaw Health & Rehabilitation Center. Over a total of 20 years, Lopez served as the Assistant Regional Medical Director for the Franciscan Inpatient Team—the first formal “Hospitalist” program on the West Coast integrating MD’s & PA’s working collaboratively together in Hospital Internal Medicine – founded in 1996.
He was the first non-MD ‘Medical Director” within any of the five Franciscan Health Hospitals and any of the 105 hospitals in 19 states that the Franciscan’s parent company, Catholic Health Initiatives (CHI), owns or operates out of Denver.
“Believe me when I say, some people didn’t know what to think,” says Lopez.
Before assuming these leadership positions, Lopez served for nearly seven years on the National Commission for the Certification of PAs, a time that he looks back upon as “a great journey.” He helped to provide “a non-primary care perspective on the national commission, build a surgical component to the exam, and have the commission understand that there is a large group of non-primary care PAs out there who need good representation on the national commission board.”
Lopez also served as President of the Washington Academy of Physician Assistants (WAPA) from 1992 to 1993. Working closely with WAPA colleagues, Lopez spearheaded efforts to rewrite state statutes and licensure for the PA profession in Washington State. “For years we had been certified providers, and then were able, after three legislative sessions, to get not just certification but to be licensed providers, which meant a world of difference regarding payment for services as well as legal support. So that was my commitment.”
Taking on the Facility Medical Director position at St. Elizabeth Hospital meant taking on what Lopez calls an “evolutionary process in leadership.”
“Like most jobs like this, you don’t know what you don’t know. You do everything that needs to be done. If you’re the manager of a small restaurant, you also wear the apron. You’ll be cutting vegetables, and you may even be sweeping the floors. When I started here, my commitment to being a success was such that I made sure that I wore the apron.”
He worked clinical shifts, managed the schedules, hired and administered physicians and PA s, wrote by-laws, developed and refined national guidelines, and looked for “opportunities to improve the care to be the best that we had to offer.” These were among the “nuts and bolts” of building a program from the ground up.
Gabrielle Zecha, PA-C, MHA
Gabe Zecha is currently Director of Advanced Practice Providers within the Division of Oncology, Transplant and In-Patient Services, as well as Associate Medical Director at the Seattle Cancer Care Alliance. Gabe has been in this position for two years, with the previous six years on the SSCA Oncology/Hematology Supportive Care Team.
A member of MEDEX Northwest’s graduating Seattle 29 class of 1997, Zecha worked on the Transplant Service at the Fred Hutchinson Cancer Research Center, then put a year into family practice, followed by a year doing General Oncology at the Seattle Veteran’s Administration Hospital, before coming to the Cancer Care Alliance in 2007 as the lead for General Oncology PA and NPs. “At that time there were 10 of us. There are now around 70. Add to that our transplant colleagues, we have about 130 PAs and NPs that are working out of this building or with our oncology patients at the university.”
In her current capacity as Associate Medical Director, Zecha is the first non-physician to hold the position of Associate Medical Director at the Cancer Care Alliance.
“Our Medical Director, who’s a great advocate for PA s and Nurse Practitioners was the one who suggested it. I’m sure there are people who don’t think it’s appropriate. But most of the feedback I get from my Medical Director and fellow Associate Medical Directors has been outstanding and very welcoming. It’s about PA-NP utilization and dispelling myths to encourage the use of people at the top of their licensure.”
“It’s quite an honor,” she confesses. “I sort of pinch myself every once in a while.”
Jon Lowe, PA-C
Jon Lowe graduated from MEDEX Seattle Class 19 in 1987, and has been a PA with Kaiser Permanente (formerly Group Health) since 1989. He currently holds the position of Physician-In-Chief for Snohomish District with the Washington Permanente Medical Group. A “good portion” of his earlier career at Group Health was spent working fulltime in clinical medicine, followed by some 15 years of working in various administrative and leadership roles. This included his time serving as Assistant Medical Director in Primary Care, with oversight of over 10 clinics and around 180 physicians.
Asked to reflect on how a PA becomes a leader and manager of other physicians, Lowe focuses his answer less on his own proven abilities than on the historically strong relationship between physician assistants and physicians that began early on at Group Health, and that has grown and been sustained over the years since.
“Part of it is me, obviously, getting the job done, and in building good relationships along the way. But I think it’s mostly about the relationships that exist at Group Health between our physician assistants and our physician. It’s been a very trusting and respectful relationship that started on in the early 1970s, when MEDEX started having its students trained and eventually hired at Group Health, and built those deep roots many years ago.”