Hospital medicine offers a unique opportunity to make a significant impact on patients' lives, and Certified PAs in hospital medicine are in great demand as Hospitalist programs become responsible for a higher percentage of inpatients.
At LifeBridge Health, we began a hospitalist program in the late 1990s, and 20 percent of patients were using our services. Today 90 percent of all patients utilize the hospital medicine service. We have 180 PAs in the LifeBridge system which includes four hospitals. Forty of those PAs work at Northwest Hospital, including seven that were just hired this year.
At Northwest, we have a 1:1 ratio of attending physicians to PAs. PAs are highly respected here and manage the day-to-day care of patients. As we review our readmissions, complications and patient satisfaction, we see no difference in patients cared for by PAs versus physicians. Patients have ever increasing expectations irrespective of their provider--the only acceptable standard is high quality, cost-effective care.
A 2016 study from another community hospital in Maryland reinforces our analysis. It showed no statistical difference in mortality, readmissions, length of stay or consultant use when there was a higher ratio of PAs to physicians on the team. Not surprisingly, it also concluded that cost of care was less in the group with more PAs.
Attracting PAs to Meet the Demand
According to the National Commission on Certification of Physician Assistants, over 75 percent of recently certified PAs had multiple job offers, so the market is competitive. We know from our experience that hospitalist PAs are in very high demand.
Our biggest recruiting tool is to precept students. We have partnerships with a number of PA programs. We think of each clinical rotation as a six-week job interview.
At the suggestion of the hospital president, we hired an internal clinical coordinator to make sure students have a great experience during their rotations here. This increases our chances of hiring the best students.
Providers in this field have to develop a relationship with patients quickly -- earning trust over three or four days. We look for simple things -- like careful listening and always sitting down at bedside level – that helps build rapport. When patients have trust and confidence in their provider they will often be more compliant, better educated to their care plan, and less likely to have complications or readmissions.
We have a good balance of new and experienced people. To help recruit experienced PAs we explain our supportive culture and that PAs work at as highly respected members of the healthcare team. PAs are compensated well, and we expect them to work at the top of their license. We believe most PAs look for an opportunity where they can continue to grow professionally, and we provide that at Northwest.
PAs also play a key role in the observation unit, which has been very successful. Basic economics means we can employ nearly two PAs for the cost of a physician, so patients can be seen more frequently. We aim to touch these patients every 2-4 hours, collect information quickly and get more timely consults. These multiple touchpoints help move patients along. The average LOS is under 13 hours, and the conversion rate is lower than average.
Retaining PAs in Competitive Markets
People want to feel comfortable in their position and their environment. PAs don't change hospitals for a few thousand dollars. If their job is rewarding and they feel respected, they will be engaged in their workplace and satisfied in their job.
We try to have a culture of "yes" toward developing our people and teams. Relationships are people managing people, not institutions managing employees. That means we recognize people's contributions and encourage them to grow professionally.
Here PAs are full voting members of medical staff and represented on all hospital committees. For example, PAs contributed heavily to the development of our EHRs because they are major users of the system.
Our scheduling gives PAs the opportunity to see the patient through admission and discharge by working continuous days. Coordinated PA scheduling helps the patients and is rewarding for the PA as well.
Those who practice here feel responsible for what patients do outside our walls, not just inside, as we educate and encourage healthier lifestyles to prevent setbacks and readmissions. We take the time to explain the importance of complying with medication and showing up for follow-up appointments.
According to the American Hospital Association, since 2014 there has been a 3.5% decrease in admissions in all U.S. hospitals but a 7.5% increase in expenses. Given the continued focus on performance and cost-based metrics, the services that Certified PAs perform add great value to the hospital team.
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Rick Rohrs, PA-C, SFHM, DFAAPA is Assistant VP at Northwest Hospital, part of LifeBridge Health in Baltimore, Maryland. He has been in hospital medicine throughout his career and has held many leadership positions in the PA profession.
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