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A niche for PAs to effect change in our health care system

Schuer, Kevin M. PA-C, MPH

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Journal of the American Academy of PAs: August 2009 - Volume 22 - Issue 8 - p 10

My experience with health care quality and patient safety was probably similar to that of the average PA when I graduated from PA school in 2007. However, my curiosity was piqued when I was asked to consider a 1-year fellowship with the National Center for Patient Safety (NCPS).1 After I was accepted, that curiosity quickly developed into a calling. Why do avoidable medical mistakes result in approximately 200,000 deaths annually in the most advanced country? Why does a health care system that prides itself as the best in the modern world significantly underperform in regard to health care outcomes? Why are measures like maternal mortality, life expectancy, and access to care consistently found to be middle of the pack, yet this country outspends other nations by as much as twofold?

As an NCPS Interdisciplinary Fellow in Quality and Patient Safety, I had the opportunity to fully understand how inefficient and waste-laden our health care system is. I also became familiar with an emerging body of literature that is encouraging and inspiring a generation of health care providers to initiate change because unaltered, our system will continue down its familiar path of producing less-than-optimal outcomes and place more patients at risk of unintentional harm. In the words of W.E. Deming, PhD, “every system is perfectly designed to achieve exactly the results it gets.”2 We simply cannot stand idle alongside a system that no longer meets our needs, nor can we accept the results our health care system consistently produces for our patients.

Two seminal publications from the Institute of Medicine (IOM), To Err is Human: Building a Safer Health System3 and Crossing the Quality Chasm: A New Health System for the 21st Century,4 have been widely cited in the past decade. The IOM is a respected think tank of provocative, forwardthinking, and systems-minded professionals who have challenged the health care industry to take a close look at itself. Some people in the health care industry have resisted the IOM's remarks, whereas others have built health systems based on their recommendations. Interestingly, a simple concept promoted by the IOM is one for which PAs are optimally trained and ultimately dedicated to support: multidisciplinary health care teams.

The IOM's belief that health care should be delivered via multidisciplinary teams is a model that is not new to the PA profession. Teamwork is a notion our profession has championed for years. The relationships fostered with our physician partners give the PA profession a distinctly advantageous position from which to enhance health care delivery and facilitate change. The IOM says that “smooth team functioning is needed because of the increasing complexity of care, the demands of new technology, and the need to coordinate multiple patient needs.”4 One of the core principles of the mission statement for the Mayo Clinic, whose credibility and innovation are revered the world over, affirms that medicine should be practiced by “an integrated team of compassionate, multidisciplinary physicians, scientists, and allied health professionals who are focused on the needs of patients.”5

PAs understand that by complementing other health care providers, we improve access, efficiency, and outcomes, and we reduce cost. This concept has been recognized for many years. Author and Johns Hopkins distinguished professor Barbara Starfield, MD, MPH, stated in 1992, “Nonphysician team members may increase efficiency, substitute for physicians, and complement physicians by filling roles that physicians may not perform well or may be reluctant to undertake.”4

If you are interested in a more tangible approach on how to affect the delivery of quality care, I strongly encourage you to speak to your hospital leaders in quality, safety, and administration. If you work in a private practice, sit down with your physician colleagues and practice managers and discuss your desire to be part of a team that is interested in making the practice patient-centered, safe, effective, efficient, equitable, and timely. Learn more about the IOM ( and other organizations, such as the Institute for Healthcare Improvement ( and the Agency for Healthcare Research and Quality ( You will find inspiration to develop a quality “niche” that will not only affect how you deliver patient care as a PA but also help to solidify the PA profession's role in a changing health care system. JAAPA


The author would like to thank the 2008–2009 members of the AAPA Quality Care Committee; Gilbert Boissonneault, PhD, PA-C; and Doris Rapp, PharmD, PA-C.


1. US Department of Veterans Affairs, Office of Academic Affiliations. Advanced Fellowships and Professional Development. US Department of Veterans Affairs Web site. Accessed July 6, 2009.
2. Pauker SG, Zane EM, Salem DN. Creating a safer health care system: finding the constraint. JAMA. 2005;294(22):2906-2908.
3. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academy Press; 1999.
4. Committee on Quality of Health Care in America, Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press, 2001.
5. Mayo's Mission. Mayo Clinic Web site. Accessed July 6, 2009.
© 2009 American Academy of Physician Assistants.