Doctoral-Trained PAs: A Scalable Answer to the Healthcare Administration Labor Gap

Peter Yen, DMSc, MSHA, PA-C, LSSGB

CEO, ADPA

Policy Brief & Implementation Roadmap

The Gap—Real, Material, and Growing

U.S. demand for medical and health services managers is projected to grow approximately 23% from 2024–2034, with about 62,100 openings per year—far outpacing the overall labor market [1]. Hospitals and medical groups also report persistent back‑office shortages (HIM/coding, revenue cycle, patient access), with two‑thirds of health‑information leaders citing staffing gaps; simultaneous pressure to automate revenue cycle tasks has intensified the skills mismatch rather than eliminating the need for leadership [2, 3]. Multi‑year workforce scans echo the same picture: an aging workforce, post‑pandemic exits, and the need to redesign roles and upskill teams [4].

Why Doctoral‑Trained PAs Are Uniquely Positioned

Physician Associates/Assistants (PAs) already bridge clinical care, team operations, and patient flow. Evidence shows PAs improve continuity, throughput, and medical cover—benefits that translate directly to administrative performance and quality initiatives [5]. Leadership scholarship specific to PA executives highlights strategies, barriers, and success factors for PAs in administrative roles—validating both the interest and the readiness of this workforce [6]. Doctoral pathways (e.g., DMSc, DHSc) explicitly build competencies in healthcare leadership, administration, policy, finance, quality improvement, and analytics, converting seasoned clinicians into manager‑leaders who can run service lines, steward budgets, and lead change. Representative curricula and certificates (executive leadership, healthcare administration/management, informatics/AI, law, global health) illustrate the breadth of preparation [7]. PA‑specific leadership competencies further formalize expectations for administrators operating above and beyond the clinical skill set [8].

Where Doctoral PAs Close the Gap Fastest

• Service‑line & practice operations. Doctoral PAs can assume responsibility for access, staffing, cost containment, and throughput while aligning clinical protocols with fiscal targets—precisely where vacancies are most acute. Evidence that PA teams enhance continuity and flow supports this positioning [5].

• Revenue cycle leadership with clinical insight. Hybrid expertise enables smarter prior‑authorization strategies, clinical documentation integrity, and denial prevention. As organizations automate RCM, leaders who understand both clinical nuance and digital workflow are at a premium [3].

• Quality, safety, and performance improvement. Leadership interventions improve care outcomes; clinical leadership strengthens engagement and quality on the front line—capabilities doctoral PAs are trained to apply at system scale [9, 10].

• Health information & data governance. HIM/coding shortages demand leaders who can set standards, integrate AI judiciously, and protect data quality—work well‑suited to doctoral PAs with informatics/QI training [2].

• Policy, advocacy, and team redesign. Under Optimal Team Practice (OTP), PAs, physicians, and other professionals gain flexibility to match local needs—opening space for PAs to serve as site medical/administrative leads in partnership with physicians [11].

Implementation Roadmap for Health Systems

1. Build a clinician‑to‑executive pipeline.

Create structured pathways (assistant manager → manager → service‑line director) and fund DMSc/DHSc or certificate upskilling (executive leadership; healthcare administration & management). Tie tuition support to performance and retention [7].

2. Target the highest‑leverage vacancies.

Prioritize doctoral PAs for roles overseeing access/throughput, clinical documentation/denials, and HIM governance—the functions with the biggest margin and quality impact amid current shortages [2, 3].

3. Pair automation with redeployment.

As RCM tasks automate, redeploy informed clinicians into root‑cause denial prevention, payer‑strategy input, and care‑model optimization—areas where clinical judgment drives ROI [3].

4. Codify scope via competencies and governance.

Adopt PA administrative competency frameworks and local OTP‑aligned bylaws so doctoral PAs can lead within clear authority and accountability [8, 11].

5. Measure what matters.

Track denial rates, days in A/R, access wait times, LOS/boarding, avoidable returns, CDI capture, and staff turnover/engagement. Link incentives to trend improvement; literature supports tying executive behaviors to measurable clinical and operational outcomes [9].

Expected Results

• Faster stabilization of units with chronic vacancies (HIM/RCM/ops) through leaders who can both do the work and redesign the work [2, 3].

• Better cross‑walk between clinical policy and financial performance—doctoral PAs translate protocols into throughput, documentation, and payer‑ready data [8].

• Improved quality and engagement via evidence‑based leadership practices deployed by clinicians who carry peer credibility [9, 10].

Bottom Line

The administrative labor gap isn’t a transient hiccup; it’s structural. Health systems need leaders who understand patients, processes, and P&L. Doctoral‑trained PAs are a ready, scalable source of such leaders—clinically credible, administratively prepared, and proven to enhance continuity, flow, and outcomes. Build the pipeline, authorize the role, and measure the gains. The bench you need may already be in your clinics—give them the doctorate‑powered runway to lead.

References

[1] U.S. Bureau of Labor Statistics. Medical and Health Services Managers: Job Outlook (2024–2034).

[2] AHIMA. Health Information Workforce Shortages and 2023 Workforce Survey.

[3] MGMA. Revenue Cycle Management Automation & Staffing Pressures (2024).

[4] American Hospital Association. Health Care Workforce Scan (2024/2025).

[5] Peer‑reviewed evidence on PA roles improving continuity, throughput, and medical cover.

[6] Scholarly literature on PA executives in administrative roles: strategies, barriers, success factors.

[7] Representative DMSc/DHSc curricula (e.g., GWU, University of Lynchburg) and executive leadership certificates.

[8] PA leadership competency frameworks for administrative scope and governance.

[9] Leadership interventions and their impact on quality and operational outcomes.

[10] Clinical leadership effects on staff engagement and patient outcomes.

[11] AAPA/PAEA resources on Optimal Team Practice (OTP) and team‑based governance.