The Missing Third Leg: Why Healthcare Leadership Needs a Doctoral-Trained PA
Picture a stool supported by only two legs. Both legs may be strong, but the stool cannot stand steadily on them alone.
Healthcare leadership can have a similar blind spot. Physicians and nurses bring essential expertise to decisions about patient care. Yet when those are the only clinical professions consistently represented in executive discussions, the team has a narrower view of how care is delivered than the organization itself requires. A doctoral-trained PA can provide a third perspective, one grounded in medical practice, built around team-based care, and strengthened by advanced preparation in leadership and health systems.
The argument is not that physician or nursing leaders have fallen short. It is that neither profession can be expected to see every operational and clinical issue from every vantage point. A health system that relies on two perspectives to design care delivered by a much broader workforce leaves useful knowledge outside the room.
What the third leg adds
Physician leaders bring medical expertise and responsibility for clinical standards. Nursing leaders bring deep knowledge of nursing practice, staffing, coordination, and the patient experience. PA leaders bring another view: how medical care is carried out across specialties, settings, and professional boundaries.
PAs often work where these boundaries meet. They see how a referral becomes an appointment, how an inpatient plan becomes outpatient care, and how physician and PA roles can be organized around patient needs. The profession’s flexibility is measurable: more than half of board-certified PAs have changed specialties at least once.[1] That experience can help a PA leader spot problems that do not belong neatly to one department.
A doctoral-trained PA can take that knowledge a step further. Training in research, quality improvement, data interpretation, and organizational leadership can help turn an observation into a proposal, and then test whether the proposal works.
When two perspectives leave a gap
Consider a health system planning to expand a specialty service. The physician executive may focus on clinical standards and specialist coverage. The nursing executive may focus on staffing, patient education, and coordination. Those are necessary parts of the plan.
A PA executive can ask how patients will move through the service:
Which visits can a trained PA manage?
When is physician consultation needed? Where will follow-up occur?
Does the proposed staffing plan reduce wait times throughout the patient’s care, or merely shift the delay to another appointment?
Without that perspective, an expansion may look complete on an organizational chart while remaining difficult to operate day to day.
The same issue appears at discharge. Physicians may see patients return with complications. Nurses may identify problems with education or coordination. A PA who works between inpatient and outpatient care may see a different failure: no one owns the first follow-up visit, or the pathway for escalating a concern is unclear. All three views are needed to design a dependable handoff.
This is what the stool represents. Two strong legs do not become weaker when a third is added. The organization becomes more stable because it can see and address more of the problem.
From a seat at the table to accountable leadership
Adding a PA executive should mean more than inviting someone to a meeting. The role needs authority, defined responsibilities, and measures of success. A PA executive could help lead clinical service design, PA workforce development, care transitions, quality initiatives, and the evaluation of new care models or technology.
Doctoral education can strengthen a PA’s preparation for this work. A published study found that PAs with doctorates were more likely to report formal or informal leadership roles than PAs without doctorates. About nine in ten doctoral-prepared PAs in that study remained primarily clinicians.[2] The finding does not prove that a doctorate causes leadership success. It does show that doctoral preparation and active clinical practice can coexist.
The leadership pipeline is already forming. NCCPA reports that about one in six PAs holds a leadership role in their main job.[1] Health systems can build on that experience by developing PA leaders who can work at the executive level and be held accountable for meaningful results.
A broader view for a more complex system
Modern healthcare is too interconnected for any one profession to lead alone and too complex to assume that two clinical perspectives capture every issue. Physician and nursing executives remain indispensable. A doctoral-trained PA adds the view of a clinician accustomed to working across specialties and within medical teams, with the advanced skills to evaluate and lead change.
A three-legged clinical leadership stool is a proposal for better decisions. It asks health systems to bring the people who understand how care actually moves through the organization into the room where that care is designed. When physicians, nurses, and PAs share that responsibility, the executive team can see more, test better solutions, and build care models that work for patients and staff.
References
National Commission on Certification of Physician Assistants. 2024 Statistical Profile of Board Certified PAs. Published 2025.
Klein A, Kayingo G, Schrode KM, Soria K. Physician assistants/associates with doctoral degrees: Where are they now? Journal of Physician Assistant Education. 2024;35(1):14–20. doi:10.1097/JPA.0000000000000549.
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