Beyond the Bedside: Reframing the PA Identity

Dr. Marilyn Suri, DMSc, MPA, PA-C, MPLC

The U.S. healthcare system is undergoing rapid transformation driven by provider shortages, increasing demand, and evolving regulatory requirements. The Association of American Medical Colleges projects a physician shortage of up to 86,000 by 2036, emphasizing the need to optimize all available healthcare providers.

Physician Associates (PAs), with over 178,000 certified professionals in the United States as of 2024, represent one of the fastest-growing hospital-based healthcare professions.² Despite this growth, PA contributions remain largely concentrated in clinical roles, with limited presence in leadership, governance, and institutional decision-making, despite further qualifications and Doctoral program developments.

To meet the demands of modern healthcare, the PA role must be reframed not only as a clinician, but as a leader.

While PAs contribute significantly to patient outcomes, their representation in executive leadership and hospital governance remains disproportionately low.² This gap limits the profession’s influence on key areas such as scope of practice, workflow optimization, and patient safety initiatives.

Healthcare systems that incorporate diverse clinical perspectives into leadership demonstrate improved quality outcomes, stronger safety cultures, and enhanced operational performance.³ The absence of PA voices in these spaces represent a missed opportunity to leverage frontline expertise.

A critical component of leadership development is understanding the infrastructure that governs clinical practice such as:

• Medical Staff Bylaws

• Institutional Policies, Procedures, and Protocols 

• Delineation of Privileges (DOPs)

The Joint Commission emphasizes that clearly defined privileges and adherence to institutional policies are foundational to patient safety and accreditation.⁴

PAs who lack familiarity with these frameworks risk unintentional noncompliance and limited professional advancement. In contrast, those who understand and engage with these systems are better positioned to advocate, lead, and influence care delivery at system levels.

In practice, gaps within these frameworks are not uncommon and they highlight why PA engagement in leadership is essential.

A clear example of disparities that arise when PAs are not represented at the decision-making table can be observed within healthcare systems, where bylaws, regulations and policies may not fully reflect current clinical practice. One such scenario is as follows: Two separate delineation of privilege documents were distributed, one for APRNs and one for PAs. Despite both groups practicing within the same clinical setting and scope. Upon review, the APRN document required fewer procedural competencies than the PA document. When questioned, the justification provided was that APRNs in this setting completed an acute care certification and were therefore presumed to have greater procedural proficiency than PAs, who were characterized as generalists.

This type of assumption-based policy development can lead to inequitable expectations, misrepresentation of competency, and underutilization of qualified providers. It highlights the importance of having a PA voice within departments particularly in the absence of a Chief PA or formal leadership structure to ensure policies are evidence-based, equitable, and reflective of actual clinical practice.

To further illustrate how these disparities manifest in clinical practice, consider a critically ill patient requiring escalation of care. The PA recognizes clinical deterioration, initiates appropriate interventions, and facilitates ICU transfer. However, uncertainty arises not in clinical judgment, but in institutional process:

Who has the authority to initiate certain orders? What documentation is required for compliance?

What are the expectations defined in the bylaws or DOP?

These are not theoretical barriers, they are operational realities.

In high-acuity environments such as the ICU, ER etc., delays in decision-making due to uncertainty in institutional policies can directly impact patient outcomes. When PAs are not fully integrated into governance structures or educated on institutional frameworks, even highly skilled clinicians may hesitate in critical moments.

Another example of this systemic disconnect is reflected in institutional onboarding education. This uncertainty is often reinforced by inconsistencies in onboarding material. In some cases, the required provider education materials and competency assessments have included outdated or inaccurate information, such as incorrect physician-to-PA ratios that do not reflect current state statutes. While seemingly minor, these inaccuracies can perpetuate misinformation, create confusion around scope of practice, and increase both institutional and individual liability risk.

Leadership is not just about decision-making, it is about removing ambiguity before it reaches the bedside.

Active participation in institutional committees is one of the most effective ways for PAs to expand their influence:

• Credentialing Committees

• Peer Review & Root Cause Analyses (RCAs)

• Sepsis Committees

• Medical Executive Committees (MEC)

• Morbidity & Mortality (M&M) Conferences

The Agency for Healthcare Research and Quality highlights that clinician engagement in quality and safety initiatives reduces preventable harm and improves system reliability.⁵ The caveat? Some institutions do not allow PA participation in the above forementioned committees.

Through these roles, if available, PAs transition from participants in care delivery to leaders shaping healthcare systems.

Committee involvement also creates opportunities to address misalignment between institutional practices and state regulations.

For example, providers may be asked to complete supervisory or delegation forms that are not required under current Florida state law, for example. In states where statutes governing PA practice have evolved, institutional policies may not always reflect these updates.

This disconnect can lead to unnecessary administrative burden, delays in credentialing or onboarding, and increased provider frustration. More importantly, it presents an opportunity for informed PAs to engage leadership, clarify discrepancies, and collaborate on workflow improvements that reduce burnout, improve access to care, and minimize delays in patient care.

The perception of the PA profession must evolve alongside its capabilities.

When PAs engage in leadership:

• They influence institutional policy

• They improve interdisciplinary collaboration 

• They advocate for both patients and providers

• They demonstrate competency beyond clinical care

This shift is not aspirational it is necessary.

To advance the PA profession, intentional steps must be taken at both the individual and organizational levels:

For PAs:

• Seek out leadership and committee opportunities,

• Become fluent in DOPs, bylaws, and institutional policies 

• Engage in quality improvement and peer review processes

• Obtain your doctorate, if able

For Healthcare Institutions:

• Include PAs in governance and decision-making bodies 

• Provide leadership development pathways

• Recognize PAs as key stakeholders in operational and clinical strategy

In states, where discrepancies may exist between state statutes and institutional policies, PA leadership is essential to bridging these gaps and ensuring safe, efficient, and equitable care delivery.

The future of the PA profession lies beyond the bedside. While clinical excellence remains foundational, leadership engagement is essential to advancing both the profession and the healthcare system.

By understanding institutional frameworks and actively participating in governance, PAs become not only providers but leaders, advocates, and architects of modern healthcare.

The profession is ready.

The question is whether the system is ready to recognize it.

References:

1. Association of American Medical Colleges. The Complexities of Physician Supply and Demand: Projections From 2021 to 2036. 2023.

2. American Academy of Physician Associates. 2024 Statistical Profile of Certified PAs.

3. Institute of Medicine. Crossing the Quality Chasm. NationalAcademies Press; 2001.

4. The Joint Commission. Accreditation Standards.

5. Agency for Healthcare Research and Quality. Patient Safety Resources.