What PAs Want in the Workplace: Involvement in Improving Patient Care

By Bianca Belcher, PA-C, director at the American Academy of PAs’ (AAPA) Center for Healthcare Leadership & Management (CHLM)


PAs (physician assistants) are a solution to the nation’s physician shortage, and can help meet patient and employer needs.  Studies show that PAs provide high quality care and patient satisfaction ratings of PAs are on a par with physicians.

AAPA’s Center for Healthcare Leadership & Management (CHLM) works directly with hospitals and health systems to enhance team-based patient care and optimize PA practice. CHLM partnered with HealthStream, a leading provider of workforce, patient experience, and provider solutions for the healthcare industry, to gain an understanding of what PAs value in their place of employment.

Based on the findings, CHLM identified five key criteria for its Employer of Excellence Awards. To help employers attract and retain PAs and improve their bottom line, this is the third in a series of articles exploring practices that lead to an ideal PA workplace. This article focuses on the importance of involving PAs in efforts to improve patient care, and one model that does so.


Ten months ago, Avon Hospital, one of Cleveland Clinic System’s ten regional hospitals, opened its doors to patients. Behind the scenes, months of planning came to fruition with the rollout of an innovative management and staffing model designed to not only improve patient care but also increase productivity.

According to Brent W. Burkey, MD, vice president of medical operations at Avon Hospital, a big part of Avon leadership’s strategy was to ensure that patients saw appropriate providers at every stage in their journey of care.

“That drove the need to encourage top-of-license practice for every individual provider, including PAs,” said Burkey. Top-of-license practice really comes down making sure that every provider can fully use all of their skills and experience to help patients.

“For PAs, it’s not enticing to go through a graduate level PA program to be a scribe, or to hold a hook for a surgeon in the operating room,” said Burkey. “We want PAs to work at the level that is appropriate to their training and that embodies the spirit of the profession they went into in the first place.”

In a world of limited healthcare resources and funding, Burkey calls PAs critical to being able to provide 24/7 care for patients.  So early in the planning process, hospital leadership determined that PAs must have an executive PA leader who could truly represent the breadth and depth of the experience and skills that the hospital’s PA workforce would bring.

That’s where Michael A. Dombrowski, PA-C, came in. Dombrowski was hired as APRN/PA director at Avon Hospital, having worked as a PA for many years at Cleveland Clinic. Because Dombrowski is a PA, he understands how to ensure that PAs are working at their highest level.

“There was a lot of peeling back the onion to make sure our providers were doing what was right for them, given their education and experience. It resulted in some people’s functions being moved around, which helped increase productivity and ultimately, revenue,” said Dombrowski. “In fact, adjusting providers’ roles resulted in decreasing our average length of stay, by as much as a full day at the main campus.”

Dombrowski also has a seat at the executive table and is in the same suite as the hospital vice president and the president. He not only oversees all APRNs/PAs at Avon, but he reports directly to Burkey, vice president of medical operations.

“When a non-clinical administrator oversees the work of a PA they often don’t know what top of licensure for PAs really means,” said Dombrowski. “While PAs report to me I report to a physician so together, we know what PAs can and should be doing. It’s really a culture change.”

Burkey suggests that it all comes down to better alignment and having providers reporting to providers. He says it sounds simple, but in many ways it’s innovative.

“This culture change has required a decent amount of managing up for PAs, and changing perceptions,” said Burkey, who knows it is working. The staffing model that Avon instituted ten months ago has been so successful that it’s being replicated in all of the Cleveland Clinic’s regional hospitals.

According to Burkey and Dombrowski, patients are the real winners.

“Having a 24/7 safe, efficient, quality care team means no delay in care for patients, no delay in discharging. It really improves the patient experience,” said Dombrowski.


CHLM works directly with hospitals and health systems to enhance team-based patient care and optimize PA practice. CHLM provides expertise, analytics, and industry best practices to help clients evaluate organizational alternatives designed to improve the effectiveness of their provider workforce.

Want to assess and improve your organization? Contact CHLM to help create a more positive environment for PAs and improve the bottom line.  If your hospital already has a supportive PA work environment, apply for a 2018 CHLM Employer of Excellence Award and be showcased as a model for excellence.