Transcript: Season 1, Episode 10

Eileen

This is Eileen Ravella. Welcome to PA Playbook. I'm the past president of the Washington Academy of PAs.

Joshua

And this is Joshua Lumsden, current president of the Washington Academy of PAs.

Eileen

This is PA Playbook, a monthly podcast hosted by PAs where we discuss smart strategies for being a PA. We talk about laws affecting your practice strategies for navigating healthcare care and issues that affect the work you do every day.

Joshua

For this episode, we're going to dive into the AAPA's national efforts to elevate PAs and support their careers, how they fight misconceptions about the PA profession on a daily basis, and how the AAPA continues to advance efforts to transform healthcare care across the United States. Our guest today is Dr. Jen Orozco, Chief Medicalist Officer and past President of the American Academy of Physician Associates. Welcome, Jen.

Jennifer Orozco

Thanks for having me.

Eileen

Dr. Orozco Cobb is the Chief Medical Officer and Senior Vice President of Clinical Affairs at the American Academy of Physician Associates, the AAPA, and the Interim Executive Director of the PA Foundation, the philanthropic arm of the AAPA. Dr. Orozco Kolb has served as volunteer leader, patient advocate, and change agent of the PA profession and all of healthcare for more than 20 years.

She's held leadership positions at both the state and national levels and is the former president and chair of the AAPA board of directors. She's a strong advocate for health equity and improving patient care access, and a champion of healthcare advocacy efforts on both the state and federal levels. She's an accomplished speaker, published author, and op-ed scholar. Welcome, Jennifer.

Joshua

Well, we just get better and better guests every time. And we're so happy to have you here today. And it's just really nice. We're just ending the season with a bang. So we'll move on to our Reddit question. And listeners, as you know, each episode we feature a question from a PA or a PA student about a practice-related issue and get our guest take on how to help with it.

Eileen

Today's question is from Reddit PA Forum, and we're going to bring on our guest to try to answer this question. Here's the question: I'm an ortho PA with 10 years of experience. Things sure are different than when I started. We've been short staffed for the better half of the last 12 months. This means our clinics are maxed out seeing 21 to 23 patients in eight hours. I remember when I was in urgent care I could see 30 patients in a day without feeling gassed. The difference is that specialty patients are generally more complex and expect so much more. I still enjoy seeing some patients and I end my time in the OR, but lately patients seem to be treating us like fast food service. I know it's notorious and ortho that patients will try to get multiple body parts looked at. I might be overthinking it, but I believe it opens me to litigation if I just drop cookie cutter recommendations without actually taking decent history in a hands-on exam. We are given 15 minutes with patients, and that includes chart time. Two body parts at max, but when I'm seen as a bad guy, if I don't examine three to four body parts in one visit and ask the patient to schedule another appointment.  It seems like any error in the office workflow trickles down to the provider staying later, charting into our lunchtime and after hours. Front desk MAs and x-ray texts just clock out and tell the patient they have to wait for them to come back.  I don't have the heart to tell a patient that their 10 minutes of time is up. I need to and I need to move on to the next patient. In regards to the management, we're actually managed by a non-clinical person. This causes a huge disconnect between what is expected and asked of us versus what is practical. We have just become a wheelhouse of getting patients in and out with subpar care. The patients feel that the visits are rushed and we feel like we don't have enough time to provide good care.  Anyone else feel like this is becoming less of a dream job than we initially imagined? I had a coworker tell me that we are living a PA student's dream. How do I cope with what seems to be the new reality of healthcare?  A common problem, Jen.

Jennifer Orozco

Well, that's a loaded question to start with and a big problem.

Eileen

Yeah.

Jennifer Orozco

I mean, you know, so first, thank you for having me. I'm excited to be here. And I think the story you just heard is a common theme and trend that we're seeing across healthcare.   So it doesn't matter where you're from, what specialty you're in.  You're feeling what's going on in healthcare care right now. And the fact of the matter is healthcare is broken. It's fractured. It's been a while. um And, you know, really this is behind why, this is why we do what we do at the AAPA. It's why we do what we do as PAs. And it's hard. It's hard work. And, and it and you know,  part of why we need change is stories like this, right? At the end of the day, it doesn't matter, you know, who's the one seeing the patient, where they are, what's happening. The reality is that patients are suffering, and we have to do something about it. And, you know, we're going to talk, I know, a little bit later in our time today, but even talking about our own wellness and our own safety and health, mental health, physical health, emotional health, whatever that is, and how important that is for healthcare now and for people who work in healthcare care because otherwise there's no one to take care of those patients that you're hearing about. And patients are suffering. You heard it. You know, they're like, how do I… I can't go to all these appointments. I don't, I don't have a primary care um provider. I don't have, the time or the money or the opportunity to um get in with specialists who I need to. So they're trying to do the best that they can when they come to see you. And so I think it can be frustrating. I know I've experienced that throughout my career. And you know this is why I think it's ever so important that we have the legislative and policy efforts that we do.

You know, the physician associate profession has such the ability to make a difference and to change healthcare if we just allow them to do so. So I'm excited. That's why I get up every day. That's why I do what I do. And I know why we at the academy and all of you right in each one of our States and our, our other organizations, this is what we're doing and why we do it. So it's a, it's a common theme and um one that I'm hoping to change in, in my time here.

Joshua

Here's what I'm hearing from this. This person is probably a very good PA. This is somebody who is conscientious, who cares about the patients and wants to do a good job. So that is a strength and that person should probably remember that. The other thing that I kind of think about though – you have this balance because you need to get the list because you like the last thing you want is someone saying, I'm defecating blood when you got the hand on the doorknob 20 minutes after. But sometimes all of these complaints are related. So for example, I had a woman who presented like within a 20 minute appointment for muscle aches, fatigue, and probable UTI. And it turned out she had new onset type one diabetes. So you get the list. But then the other thing I tell patients is I want the list, but if I cover five things, I promise you I'm going to make a mistake.   And I promise you, I'm going to gloss over something. And I do not want to do that. You're worth more care than that. And we can do a follow up if you need to. And they tend to accept that really well. It takes some training over time. But over time, when I build that relationship with patients, it's often very productive and very fruitful. So agenda set hard and remember who you are as a PA is what would be my advice for this person.

Jennifer Orozco

Yeah, and you know, and I'll say as someone who's specialty, right, so this person practices in ortho, I practiced vascular surgery for a majority of my career. And for anyone who knows vascular, they're some of the sickest patients out there, right? So they're coming in with their multitude of complaints. And I agree, Josh, and you know, communication is key, that relationship with your patient is key, and that bond that you have with your patient is key. Building that trust, having that open relationship, whether you're coming in for another visit or you're having a conversation on the phone later, that's where we're going to start to see improved outcomes with those folks, but you also have to take care of yourself and remember that you have the ability as a PA, right? You have the training and the education to take care of the whole person, um and you can do that no matter what specialty that you're in, even if that means you're calling your colleague and getting them in where they can have a different level of care than maybe what you can provide in your specialty. um You have that ability and knowledge to know where they should go.   Yeah, um absolutely agree with your statement.

Joshua

And you know, we developed this really innovative program at the clinic system that I work at Virginia Mason.  We have something called a cafe group. And so we've actually secured funding to have these dinner groups with our colleagues and it gives us a chance to decompress and take care of each other. We actually get money towards our dinner that night and it's become very, very valuable.   So take that time to bond with your medical assistants, your front desk, your colleagues, and that will help with that burnout.

Eileen

You know, I find the same thing when people come into urgent care because they can't get into their primary care doctor and they bring a litany of their complaints. And I usually set the expectation with what is the most concerning issue that I can address for you today? Because I can't do all of these today. And people get it. They don't say, oh my gosh, I can't believe it. They're just happy to get seen that somebody's finally talking to them. And you said and then you make the fall appointment, as we have just said. So yeah, there's ways to manage it. And you're not going to make everybody happy, but I think you can do the best you can.

Joshua

But get the list because the last thing you want is - I've got this crushing chest pain. I don't want to let that go through the weekend – at the end of your visit when you're already behind because that becomes the priority over their refill of their acne meds.

Eileen

Yes.

Joshua

Yeah, yeah, yeah.

Jennifer Orozco

Yeah.

Eileen

Yep. All right. So Jen, tell us about your journey. How did you get from practicing, practicing PA to president at the AAPA? I mean, you've held a lot of leadership roles.   So I think you're, you're an inspiration to a lot of PAs out there thinking, I want to do something more than just do clinical medicine. What, what, ah tell us about that journey.

Jennifer Orozco

yeah

Eileen

How'd you get there?

Jennifer Orozco

Well, if you know me starting out over 20 years ago, I could have never called where I am today. And you know, I think Where most of us who go into medicine, I would say are type A in some sort of way. And we have a grand plan of what we think it's going to look like, right? This is the path I'm on. This is where I'm going to go. And I can tell you my journey has not been that whatsoever. It has taken so many side roads. It's gone backwards. It's gone forwards. um You name it. And, you know, I think  one of the things that has always kept me going is really finding that passion and then what you're passionate about. And some people are really good at some things and not others, and you figure out what your strengths are. And, you know, when I started as a PA, um the profession was… new is not the right word, but I was in an organization that didn't necessarily know my capabilities and what I could do. There weren't very many of us. I was the first PA in the practice and people didn't know what I could do. And um I was told no. I was a vascular surgery PA and I went to take the staples out of a patient's bologna amputation.

Jennifer Orozco

And a nurse reported me for practicing out of scope because only nurses took out staples and sutures. And this is a long time ago now, right?

Joshua

bless her heart.

Jennifer Orozco

But at the same time, it really fired me up to say, that is not a true statement. But I actually didn't have the evidence to prove it. I knew it in my head.

Jennifer Orozco

I knew by my training, I knew (and you know)... my board exam, I knew I was trained to do all of these things, but it really got me thinking of where does it actually say it? That is what sort of my journey into advocacy started, it's where it started to go. so I started to look at state law and policy, then I started to learn about your facility policy and medical staff bylaws and payer policy and all of these things, HR and you know, it really opened my eyes to a world of, but one, do we have it written anywhere? And two, are we in it? And so there was lots of policy about everything, but PAs were often not mentioned. And so thus started that journey. um You know, it was a crooked one, right? So I did my clinical and my ICU time and my OR time for a very long time for many years, and then sort of became the voice of PAs internally, unofficially.

And like I was at an organization where nurses and physicians were the supreme rulers… we had the number one NP school in the country.  And so there were nurse practitioners, but they were also not that many. And so I had the opportunity to work with several and we really sort of joined forces to say, what is this NP/PA thing and why aren't people paying attention? And it really was a great effort that just led to many, many things. I mean and was asked to become faculty and become the director of clinical education, helped start a PA program at the university that was attached to the academic medical center, which then led to more advocacy on the state level and policy and eventually up to AAPA. And it just offered me so much opportunity along the way. And I didn't know what I wanted to do.

I was good at clinical, I was good at faculty, I was good at advocacy and policy. And really, I think in probably about 7 to 10 years…  and started thinking about what it is that I'm really passionate about.   And it was really making health care available for all. And I knew that PAs had a great ability to do more if we could just unleash that. And not only PAs, but other folks. ah you know, whether it was an NP, whether it was a nurse, whether it was a physical therapist, like why aren't we utilizing people the way that we should in healthcare? care And so it became a passion. It has led me to um different relationships and opportunities that have presented themselves.  The PA presidency…. The AAPA presidency also was um unexpected, right? I was the first AAPA president to serve two years. um and what did that mean? and It was a lot, but it offered me the chance to take ah to move out of my local and state level and really have a voice for PAs at the national level.   And that turned into my passion and it has led me to a lot of conversations with folks that aren't in medicine per se, but are attached and have influence in some way, shape or form. And that's where I love that space and talking to those who will listen and those who are willing to do things innovatively and differently.

Joshua

And you know what?  When I go through like admissions essays, because I sit on an admissions committee for a university PA program, um and nobody yet has said, I want to be president of PA when they're applying to PA school.

And it sounds ah like a lot that your approach is when someone says, no, you're kind of like, you wanna bet?, and then you figure it out and you get the documentation.

Jennifer Orozco

yep

Joshua

So I can relate to that really well.   What would you say your biggest accomplishments were as president of the American Academy of Physician Associates?

Jennifer Orozco

Yeah. Well, I think it, you know, some of, so there was a lot that happened in those two years. I became president in the post COVID era. Um, so it was really, what do we do now? Um, we had, we hadn't had a conference, right? So it was re, um, you know, turning back on that conference and coming together.

And we knew that healthcare care was changed forever. So what did that look like now for the Academy? What did that look like for PAs? And with this knowledge now that if you unleash PAs, the impact that that could have, we saw what happened during COVID um and that opening up the the laws and the regulations and the freedom for PAs to practice as they were meant to practice, and the impact that that had in healthcare and on patient population was tremendous. And why would we only do that during a pandemic? Why would we not do that every day? We are in crisis right now. There are 74 million people in this country without access to primary care, 155 million without access to mental healthcare.   We have a growing aging population, more than 81 million people in this country are going to be older than 65 by 2040. Who is going to take care of all these people?

It doesn't matter how many physicians, PAs, NPs we produce in the next 15 years, we're still not enough.

Joshua

There is plenty of work to go around.

Jennifer Orozco

Yeah, so, you know.

Eileen

Like you, I was president during COVID. And we were able to get the governor to unleash the PAs without supervision. We got, you know, we said, can you do that? And he said, of course I will. And it was like, what? You will? And so he made a decree that yes, PAs, if you need to go somewhere to help out during COVID, you are going, you don't have to be supervised. And it was phenomenal. The people that could move, did move, and they served their time at a really difficult time.

The interesting thing was after that timeframe was over and the and and the governor said, okay, you got to go back to where you were, it's hard to unring that bell.  But we still got pushed back from the state medical association about, well, that was fine then, but you still can't do it now.

Jennifer Orozco

Yeah.

Eileen

so you know It's a nice frame of reference, um but we've got to figure out how to utilize that better for us because it is a true statement and we did do it and no one got hurt.

Jennifer Orozco

Yeah. Well, and what's the reasoning, right? So that's usually what I say to folks.

Eileen

Exactly.

Jennifer Orozco

I said, we're safe and effective providers when there's a crisis, but somehow when there's not a crisis, we've lost that safety and quality, even though there's mountains of evidence for the last 50 years saying otherwise.

Eileen

Exactly.

Jennifer Orozco

So again, it's… it's something to fall back on, but I think it's showing what being bold and taking different actions can create. and that is when you know part of my presidency was really about being bold, thinking differently. And in medicine, we're such traditionalists. It's how medicine has been run. And whether you could say it was successful or non-successful, I would say right now we're on the unsuccessful side of medicine being run in this traditional sense. The way medicine was….  Is…. is gone.

Jennifer Orozco

Everything is different. Everything post pandemic is different. And we have to be able to adapt and flex and do better than the PA profession to do such a thing. That's what we were built for. We are meant to adapt and flex. We have the training, we have the experience, we have the capability, and we have more than enough evidence over 50 years to prove that. And so how do we pull those triggers? How do we unleash this workforce?

Because honestly, at the end of the day, I'll say it again, but it's the patients who are suffering. Someone has to stand up for them, and I know that we are doing that as a profession, as an organization, and we want what's best for them. So that's what keeps us going. We're going to keep pushing. And yeah we're not here to make everybody happy.

Eileen

That's right.

Jennifer Orozco

You know, everybody's not gonna agree, that's okay. But we can be, we can really move the needle forward about what the future of healthcare care looks like. um And, you know, I'm excited for it.

Joshua

I would agree with that a hundred percent. I think that the traditional model of medicine actually alienates a lot of marginalized people. It's especially true for my transgender patients who are terrified of the medical system in general.

Jennifer Orozco

Yeah.

Joshua

So that tracks.  What Jen is different now as chief medical officer from before. And how do you support the current president, Jason Prevelige, to carry out the AAPA's policy goals?

Jennifer Orozco

Yeah. You know, it's such a good question. I think I'm living my dream job, right? I mean, there's no doubt about it. It really allows me to be the voice of the profession on a daily basis, especially in the weeds with operation. So whether I'm talking to PAs or whether I'm talking to corporate or industry partners, or I'm sitting in the White House having conversations,

Jennifer Orozco

It allows me to be working on changing healthcare every single day and putting strategy and operations in place at the academy and being that voice at the AAPA at the senior level so that everything we do in the academy has that PA voice and has that level of thinking innovatively. Where do we want to go? What are you not thinking about from a clinician standpoint that you need to be thinking about from the academy?

Jennifer Orozco

And, you know, supporting president Prevelige is one of my main jobs and one of my main roles, right. He is the president of the Academy and the voice of the Academy and they set…. the board sets direction for where we're going. And so for me, it's enacting that direction for the board and enacting how bold they want to be. And even you know doing the push-pull, like, hey, we need to be a little bit bolder. Let me tell you why. And they push on me to be bolder and think about it. And that's what the beauty of that relationship is. And you know, we can get so much more done when we're all kind of spreading that message and spreading out that work rather than just a single individual's responsibility or another person's responsibility. And, um you know, being CMO has offered me an opportunity to talk to people who will listen.

Um, and they're usually not the people that you would think, but have, as I mentioned earlier, a lot of influence in space. ….that's what we need to be doing all the time, 24 seven. And that's what we're doing. Um, and, and what I'm doing. And so I'm excited about that.

Joshua

I have a follow up question, so this is a dream job. What is hard about the job or what is a hard day like in the job that you've got? Like what is that like?   Because no job is perfect, um you know, and like you know, like we just try to.

Jennifer Orozco

Gosh. I think one, the volume, right? There's so much work to be done.  And everybody wants a piece of the CMO, right? In some way, shape, or form. and because you are the PA in the room, right?

So they want to know, and they want the PA input. So um you know the volume of work that can be done, how do you prioritize that work? What comes first? um, meeting the needs of everyone, right? So you all are from Washington state. You have different needs than what the Texas PAs need or what the state of Maine needs. I mean, and the patients there. So how do you balance priorities across the United States? How do you think of our international folks and what's going on outside of the US? So it's a lot to juggle. um I think the other thing is growing the academy, right? Not only are we here for the profession, but we also are an organization and a business. And so we have to continue to grow

As the profession grows, (we) make sure that we're supporting the next generation of PAs. And so they're the fastest growing, right? Those coming out. They're a different generation of PAs. They have different needs than my older set of PAs who have been around for a long time. And there's all kinds of different generational issues in the PA profession that really didn't necessarily exist before, but have really become prominent, especially post-pandemic. And so it can be a challenge. It's a fun challenge to have… I enjoy it. And I think you know like anything, we sometimes…. where I get frustrated is…. (with)  what's going on in the political world right now, right? And we've such extremes on both sides. It doesn't matter whether you're right or whether you're left or whether you're in the middle, we are all PAs. And so we need to come together no matter where you are. And that is really difficult to move policy um when we have a lot of challenges at both the federal and the state levels. So um it's a challenge, but we're going to keep pushing forward because we know it's the right thing to do. And we're going to keep pushing for our patience and for equity and our mission and our vision because it's the right thing to do.

Eileen

So earlier you alluded to making a bold move … give me an example of what a bold move is from your perspective, because there's the push and the pull.   Some people want, listen, we need to go…. guns a-blazing,  or no, we need to sit back and we need to just, we just need to let it be. So tell me, tell me what that boldness looks like.

Jennifer Orozco

Yeah, well, you know, I don't think bold means guns-a-blazin'. I'll tell you, my younger self might've thought that. and Back in the day, right, and I was gonna bang my fist on the table, that was how I got stuff done.   I was a doer, I demanded it, and I and I think over time and experience , (I) have learned that that approach is probably not always the best approach. What I mean by being bold is thinking differently um and taking calculated risks.

Anytime you make bold moves, there's going to be risk involved. And I think for us, we as a profession and as an organization need to start delving into doing things differently. Right. Moving away from tradition and (yet)  still having tradition, but moving in a direction that lets us do things differently and taking risks that may pay off… that are not going to be harmful.

Jennifer Orozco

But can you imagine if they worked and they paid off and not doing it in, you know, five years from now, like doing it now. And so sometimes it's better done than perfect um and really trying things and failing. I mean, there's one thing that I'll tell you in the role that I'm in and the roles that I've had over the years, it's learning how to fail, learning how to fail fast, learning how to learn from those and how to move forward. And unless we are willing to take a leap of faith and fail, we're gonna be stuck in the place that we are as a PA profession, and no one will be winning. So we all have to be willing to step outside, take those risks, and it's gonna take bold leaders to do that. So for me, it's helping people feel comfortable with that and to be a leader who can do that and be okay with failure. Is it really a failure?  No, I think it's an opportunity to do something different.

Joshua

In sports, there is this expression like in rugby: when I played it, the coach said(to) fail at 100%. So even if you don't think you're going to make it over the line, do everything you can to get over and fail at 100%. So it sounds like that's the approach.

Jennifer Orozco

Yeah, absolutely. I'm a cyclist, and one of the lessons I learned… I race bikes. and my coach used to say, it's better to run out of legs than run out of runway.   And so and that really was about not pulling the trigger and giving that 110% till you had nothing left.

And that's how you lost the race rather than you just didn't pull the trigger and you still lost the race. And so for me, it's really thinking about what are those things that we can do and try and change and pay off big for patients being the profession. Sure. I want the profession to win, but really it's the patients who I want to win. That's the whole reason that we keep going and doing what we're doing.

Joshua

Agreed. Just hydrate well, Jen, please.

Jennifer Orozco

yeah

Eileen

So we're going to move on to demographics a little bit.  So a study of the Journal of PA Education noted a trend towards applicants to programs with fewer hours in patient care experience. um And we're moving away from the historical picture of military medics with tons of experience and applicants from diverse with diverse experience. There's also a shift towards more female applicants. How do you think this will impact the PA profession?   …do you agree with that? Do you agree with, ah you don't need you don't need as much clinical hours to to apply for PA school.

Jennifer Orozco

Yeah, well, I don't think it's agree or disagree, right? i don't I don't think there's any necessarily right answer because there's so many factors that go into an applicant, right? Whether depending on their experience and background, um how many direct patient care hours or nonpatient care hours, I think what's really important is the quality of our programs, and the quality of our education, and the quality of their clinical experiences that they have during that time frame. And that has really set us apart as a profession. We have some of, well, I'll say we have the most rigorous um accreditation requirements in order to graduate from PA school. Sometimes I think they're a little too much.

Jennifer Orozco

I even remember when I was at the University, um, the Dean at the time…. he goes, and we were new, we were the new program in the university. And he said, he called me in the office and he said, could you please tell me how, why this is? He goes, this is harder than the medical college accreditation. And you know, I've never understood this. He goes, why do you do it this way? And I, and I said, well, I think it's because PA's felt that they've had to prove themselves over and over again, all these years.   And the one thing we're not willing to let go of is the rigor of our education because we have to treat the whole patient, right?

Eileen

Right.

Jennifer Orozco

We may have to change specialties or locations or you know… (the) patient population. And… that is something we pride ourselves in.   And I think that's what's really most important. And you know it's on programs and they struggle depending on what program they are with how to vet applicants. I do think we have to really think about how we look at applicants um to diversify our pipeline of PAs. I do a lot of work as CMO in the grant space and one of our programs is our pathways program, which seeks out to diversify the profession.

… how do we expand that? Not only to racial and ethnic minorities, which are not prominent in medicine in general, but also all of those folks inclusive. So whether it's LGBTQ, whether it's those with disabilities, whatever religious, whatever it is that we're thinking as a profession; am I making the right decision when it comes to applicants?  ….and who's entering the profession because it's so important for us, it's so important for medicine, and we know patients fare better with outcomes when they have a provider who looks like them, understands them, um and…. (whom) they can relate to. And that is part of what we do as an academy, and I think is a really, really important aspect of PA programs, and they really need to be thinking hard about what that means. And not only just getting them in the door, but then how do we support these folks that otherwise have not had the support prior to entering PA school, right?

And how do we make sure that they're successful through PA school? Because it's hard. I mean, I'll tell you, many years ago, I would never do it again. and so say People ask me all the time, would you do it again?   I was like, I don't think so. It was so hard. Now, I was young, and (now) I don't know what my choice would be.  It was the toughest two and a half years of my life back then. and Um, it's very rewarding and I'm in a great place where I am now, but it was really, really hard. So we have to help them, um, and support them throughout their journey.

Joshua

You know, I was at the WPATH (conference) in Lisbon, the transgender conference a little bit ago. And one of the quotes that came out from that was nobody knows what you will want in 15 years, except for yourself in 15 years.

So, you know, it was pretty profound…. it was in the context of adolescent gender affirming care and…  the right to regret your decisions…  it was just an interesting point.

We're going to pivot. When I look at Reddit, I notice a lot of people and post that they are choosing “the PA route” because they think that they will experience better work-life balance compared to physicians. What do you think of that assumption?

Well, as someone who comes from the vascular surgery world, I would say, I would think that's the wrong assumption so as a student and not the reason to get into becoming a PA.

Admittedly, I will say my 20-year-old self back in the day,... (would) probably have the same assumption. Oh, it's work-life balance. I've seen that even on social channels, you don't have full responsibility for the patients or decision-making. You always have a backup. And I think these are some of these misconceptions that exist out there today.   Um, you know, I said, people used to ask me, I used to cover the ICU at night and I'd be by myself and the cardiac, the CBT ICU.   And they'd say, well well, what, what if there was an emergency? And I said, yeah, what if there's an emergency?

Joshua

What do we do?

Jennifer Orozco

Well, what do you do? And I said, yeah, we were, I was opening people's chests and the nurses and I were doing CPR and running codes and we're going to the OR and I'm paging the surgeon to come in and we're fixing them.

Jennifer Orozco

And they're like, what do you mean? And I think we really do a disservice when we allow others to kind of fill that, oh, it's going to be great work-life balance. No, you either want to practice medicine or you don't. And you care about patients or you don't. And so accept that. Look back to 20 years ago when I started, I could have never predicted where we'd be at the state of health care right now.   I couldn't have called it in a million years. We were in private practice, and this is how we ran, and there was no merging of healthcare systems. There were no giant behemoth healthcare care systems. there was no you know there or There wasn't even that many PAs back then. you know so I couldn't have predicted where I would be and I can't predict where we're going to be 20 years from now. So, you know, I would caution those very strongly to get into it for work-life balance because I'll tell you the first, I don't know, and this is 20 years ago, the first five years of my career, I was doing 16 hour days and being on call and going to the operating room. So I'm not quite sure where everybody necessarily finds the work-life balance, I think you make your work-life balance if there is one. It's your choice, how you want to practice, where you want to practice, what you want to do, um and you find what works for you, and you find what works for yourself, your family, your kids, your partner, whoever it is.   And it really is a decision, a conscious decision on your part of how that works and what works for you.

Eileen

Yeah, I agree. I think you have to go with it with your eyes wide open and realistic expectations. But there's a big movement within medicine to establish, I mean, I hear it all the time, from physicians, not just PAs. I want a work -life balance. So I'm only going to be a 0.5 FTE. So I only have to work three days a week, and I only get to do this, and I'm only going to do that. Well, somebody else is going to pick up that other 0.5, and guess who it is? It's the PA.

So, it's sort of become this predominant narrative that if you're going to do medicine, and there was a recent article in the New York Times about these older physicians, these medical school graduates coming out and saying, you know, I really don't want to work that hard.

Jennifer Orozco

Right.

Eileen

So, and these old guarders saying, what are you talking about? This is medicine. This is what you do. You're not working at a bank. you this is what you do.   And so there's a new movement within medicine to establish whatever that looks like. I have no idea what that word (means). I never had that. I tell you I never had that would have been nice.   But I took it upon myself that's part of the deal.

Jennifer Orozco

Yeah.

Eileen

So I agree with you that you just gotta bite the bullet and then figure out where you land with a realistic expectation.

Jennifer Orozco

Yeah. Well, we talked about the generational gaps a couple of you know a couple of minutes ago, right?   And if you just think in terms of generational approach to work and to your life, we're very different on the spectrum, right? and i And I'm a Gen X-er, so I'm caught in the middle of both lands is what I always tell people.

Joshua

I'm an exennial too.

Jennifer Orozco

Yeah, I had the parents who you just worked till (they) dropped and it didn't matter, you shut up, you showed up to work. And that's what you did. And that's all you did.  And you came home and that was okay. And then we had a different generation that is a little bit more, okay, well, it's my decision what I'm doing.   So where do we meet in the middle? And I think some of the signs that we see too, in my mind, right?

Because physicians, you're right, absolutely have the same trend. Healthcare, people in healthcare that work in healthcare care are suffering. So they're starting to take control of their lives back. We cannot continue to have the expectations on them that we have. This is why we need to do things differently. This is why we need different structures. This is why you need to unleash providers who have the skillset to do what they need to do because people are suffering And so to me, it's just a symptom of all, that's why people are working half FTEs and, um you know, partial this day, that day, not the weekends, not call, um because, you know, they know what that means for them. And it's a problem in healthcare we have to fix and we got to figure out how to do it quickly.

Eileen

So one of the things that's happening with the medicine, I'm sure you know, are all these mergers and consolidations are going on in these big hospitals taking on more clinics and more health care systems, which I believe is creating a too big to fail system that I don't know if we can come back from that.

So how does AAPA look at that, and and and what are your thoughts about these big consolidating mergers, and and which is not helping medicine in my opinion, but tell me what, AAPA, they have a stance about this.

Jennifer Orozco

Yeah, well, I don't think I can speak to a stance. I mean, I think what I can speak to is that we're always watching and we're always assessing. And for me, it's always going back and talking to PAs about what this means for them. I think it's really overwhelming and stressful when you think about what's happening in medicine, right? And so what happens when we do that? One, we become very stressed over the future state – my husband calls them mind movies. We make up our mind movies of what our lives will become, right? And it causes tremendous anxiety. But I think when you start to think about what can I do at my level, what impact can I have in my community, my healthcare system, whatever it is, and and really focus on what you can control, but also think about

Don't just live in that small space. You have to think about the others around you and the others outside of you. In different states, what they face in different parts of the country, um and really take your blinders off, understand your space, affect what you can do, but also remember that any and anything you do has an impact on those around you. And so for me, it's helping PAs understand what's going on. It's helping people be aware of what this means for them and preparing them as best we can…. to practice, so they don't have all this anxiety of what may be and what may come because it's incredibly stressful already to be someone then to be someone that works in healthcare.

Joshua

about the mind movie thing, you know, in your own mind movies, Eileen Jen, who, what would your mind movie be like?

Would it be a Spielberg movie like ET? Would it be a Marvel movie? Would it be an art film? Cause I think mine would be like a Fellini film, but like, like what, like with all the weird Italian visuals, but who would, what would your mind movies be like?

Jennifer Orozco

Well, my, oh my gosh, my mind movie, um, you know, I think it's, there's probably two extremes. If I used extremes, extreme mind movies… World war Z.   Sort of The Mask, I know it's zombie, it's a little silly, but at the same time, it's sort of pandemic-ish, right? So that mind movie of what can happen and then not having resources and ability to to take care of all these people that have ah afflictions.   And then I sort of also think the other extreme of the movie, for lack of a better term, is the iRobot and what happens when the machines take over terminator kind of thing, right?

Joshua

The humanity is lost!

Jennifer Orozco

Like, what is going to happen and in healthcare care in those sort of two pathways of no resources or like global pandemic kind of and issues happening all at the same time and not being able to get ahead. And then sort of this technology that none of us can get ahead of either, cause it's moving so quickly and so fast. And what does that mean for healthcare? It's so good. And at the same time, so frightening. And so how do you inform yourself? How can I keep up with how fast medicine is changing, how fast healthcare care is changing? So those are my two extreme movies, I will say.   But I wish it would be more like… a romance. That's my goal movie of the romance that we all fall in love and work together and everybody lives happily ever after, right?

Joshua

Yes, The Notebook or something.

Eileen, what's your mind movie like?

Eileen

Well, my movie is Wonder Woman, of course.

Joshua

Oh, I love that. I love that.

Eileen

I mean, come on.

Jennifer Orozco

I know I like it.

Eileen

I'm going to come in and I'm going to fix it.

Joshua

I'm going to send you some armbands.

Eileen

When I was working the ER, my husband would bring me lunch in a Wonder Woman lunch box. …in my 40 years of working as a PA, I always wanted to try to make the change that was most impactful. I mean, my goal, I remember when I started my profession, I remember thinking out loud to myself, I want to make a difference.

I don't know what that looks like, but I want to make a difference. And I feel like I have to some extent, but I, I, that's, that's where I want to be. I want to be at the forefront of how do you make this change? How do you make it?  How do we move forward? How do you bring everybody along? Not everybody's going to agree. And I'll let you, I'll let you fall by the wayside if you don't agree, but we'll, we'll bring you along at some point.

Jennifer Orozco

Yes.

Eileen

I mean, that's sort of my, my vision. And I think that it takes superpowers to do that. I just, so that would be my, my mind movie.

Jennifer Orozco

Nowhere to go is Avengers, if we need powers, right?

Joshua

Yes.

Jennifer Orozco

Like it's kind of that, there's it well I don't know which you one it is. I think it's the last one. where everybody starts showing up to like support one another to to I don't want to fight but like when everybody starts showing up to support one another like that's my that's my like health care dream of we're all here in this together yeah that's really

Joshua

It's the Care Bear stare. you know, basically yeah so where they kill the bad guy by making the rainbows come out of their belly altogether like in unison.

And so that's the way it should be. I chose Fellini just because I, you know I am driven by that patient relationship and those compelling characters and those mundane details of life are sometimes the most beautiful.But also I have like this slight… dread sense of angst… occasionally and like a little bit of like imposter syndrome and it all fits in there really, really nicely.

Jennifer Orozco

Yeah.

Joshua

Jenn, a survey from the NCCPA, which…  you know is responsible for certification, found that over 30% of PAs had at least one symptom of burnout and that 8% of PAs indicated they were planning to leave the profession in the coming year.   Informally, a lot of them are quiet quitting, which is that phenomenon where you kind of do the bare minimum that's right for your job and your patients, but you don't do a lot of committees or a lot of extra work. Why do you think this is and what do you think can be done about this?

Jennifer Orozco

…we've been studying burnout in health care for some time, specifically among PAs, and I'm not surprised, right? Because at some point in all levels of healthcare, there's burnout, but especially for providers. um you know we've been studying, um I think I did my first study on burnout back in 2014, 15, and the academy has been focused on it for even several years before that. I know we had a whole task force on burnout.  We have a whole section of the website dedicated to PA wellness as well as resources and data for them.  Part of our data actually uncovered that almost 41% of PAs have one or more symptoms of burnout and over half, 56% of PA students have one or more symptoms of burnout or are completely burnout.  So they're burnout before they even get into healthcare.

Joshua

Yes.

Jennifer Orozco

And so the good news is, is I think, What we did find in that data and that research is that we have overwhelming um optimism about the profession and about the PA profession, not so much for healthcare per se. So what does that mean? And so I think what we've really worked on with not only that task force, but even in the academy is around building resources for provider wellness, making sure PAs are informed, and also what are they doing to take care of themselves? And I'm just going to use my example from my own mental health. And I've written about this and some op-eds and some others around my anxiety and depression, especially that happened with the pandemic. And um you know at the organization that I worked in, I was sort of I had to be put in the executive side of the house. And even though I wanted to go to the bedside, I was one of the leaders that needed to sort of organize and coordinate what was going on. And so the toll that that took on me to take um my young PAs, NPs, and I shouldn't say young, I should say all of them in physicians, I was put in charge of provider redeployment and to make them go into these areas where, you know, the future was uncertain.

(it was) pretty challenging. And then also having all the personal stuff, right? I was a single mom. I had three kids at home that I couldn't be with. I was in the hospital 24/7. Um, I was dating someone through it at the time. We had a lot of challenges. And so the toll that that took on me, um, was tremendous. And it also allowed me to realize that a lot of providers do not talk about their own mental health. We were actually taught not to, to, for fear of losing license, for fear of stigma. And I got tired of that. And so started writing about it and just having PAs and other healthcare care providers open up and be open about their mental health and the challenges that they face. And it was so important to talk about it because we expect our patients to. So we need to demonstrate that we can do it and how do we support one another? um and And it really uncovered people that I would I had no idea we're struggling started to come out of the woodwork and say okay well if Jen said it I now feel safe to say it and that I'm having challenges and I couldn't have predicted people were texting me and so we have to find … that group amongst ourselves to help support one another. So whether it's online or whether it's in person, you have to have that support system because it's just hard. It's hard being in healthcare. care it We're also people. We're human. We have these other lives outside of our patients.  And that's okay. And we have to be able to talk about that. And, you know, so tons of resources are always here to talk to anybody who has any challenges and, you know, ah we need to do better in this sense and make some changes.

Joshua

We (have) got to normalize it and we got to make it relatable to patients because we're not perfect. And I think that vulnerability sometimes is an asset. 

Eileen

So there's a widespread effort by the AMA that advocates against what they refer to as scope creep. Tell us what is scope creep? What does the AAPA think about that? It's a big subject I know.

Jennifer Orozco

Well, I don't, you know, here's the reality. I don't know what their so-called scope creep is. It's something, it's a word they made up. It's something that they call it. And it really is something that is very detrimental to moving forward with healthcare care and what we need to be doing with patients. and um It has become very clear, it's on their website. They are spending hundreds of thousands of dollars in efforts in every state to combat what they refer to as so-called scope creep. And really what it is, is PAs practicing to the fullest extent of their education and training and what they're supposed to be doing. um You know, there is a thought that there should be a permanent hierarchy in medicine and that you should be asking permission from certain individuals in order to practice. And that's really just not what it is. I'll tell you what this isn't though, is what's true is that the AMA does not represent all physicians. And in fact, the majority of physicians do not belong to the AMA. However, the AMA is powerful and influential. And so that comes with a lot of responsibility. And I often will say to those who tote around the damage that they're causing, and it's not just us.  They're at after everybody, whether it's a PA, an NP, an optometrist, a pharmacist, a psychologist, it doesn't matter… that there is a supreme being to all of healthcare care, (and it)  is really an outdated one and an unfair one because it's only patients who suffer. Everybody has the right and the ability to practice to the fullest extent. And if we just allow them to do so, our healthcare care system could be so different and patients could have access. We'd have economic stability. I mean, we'd have so many things that could happen Um, if, if people were just allowed to do what they were educated and trained to do. So this is a distraction in my mind. This is something used to distract legislators. It's something used to distract policymakers, and frankly, there's no evidence or data behind it whatsoever. And in fact, it's the complete opposite to the contrary. But we live in a world where we're having some extremes, especially in this arena with the policymakers. And we need to continue to combat this. I deal with facts. I don't deal with drama and theories, and I don't deal with things that are not true. We have mountains of studies that talk about this.   And the the studies that seem to be floating around are really poorly done and they should be ashamed of themselves for sharing them.   So that is not what we should be sharing. And I'll tell you, PAs aren't trying to be physicians. I don't think any other group is either.   We're trying to be PAs.

Joshua

I think lately, based on that New York Times article, sometimes physicians aren't even trying to be physicians.

Jennifer Orozco

You know, it's crazy.

Joshua

They're leaving too.   But I get your point.

Jennifer Orozco

Right. Right. Well, and I'll tell you, I know so many physicians. I came from a great organization. There are so many pro-PA physicians and want to do health care differently.   And this really does, AMA does not represent them. And they just want to better their communities.

Joshua

No.

Jennifer Orozco

And those are the folks that you know, we need to talk to and keep working with and keep, you know, delivering the health care that people deserve. And I think in the end, that's where we will get to. And this needs to go away. People are tired of it. The states and the federal, they're tired of hearing it. And they're like, this is enough. We're suffering. Our patients are suffering. The population is suffering. We need to do something about it.

Eileen

Well, we've got to get rid of the paternalistic model that we've had in medicine (from when) ….time began in medicine.   And that's what's driving this from my perspective anyway. So tell me, what do you think? I think I know what your answer is going to be. What do you think people get wrong about PAs?

Jennifer Orozco

Oh my gosh. I think it depends who you're talking to.   There's so many misconceptions about PAs, right? One that we assist them, right? That we assist people, um that we don't make independent decisions. um that we don't have the skill set to take care of patients in the way that we do. And in fact, um we've been doing it since the 1960s, right? And so um people make so many assumptions rather than informing themselves with facts.   And you know the assumption that PAs do not make independent decisions or autonomous decisions or have the ability to be leaders in healthcare, care that's one thing that I'll tell you has become sort of a priority for me.

PAs have such depth and knowledge in their background and in their skill set and their experience. They can be leading healthcare systems, healthcare care initiatives, organizations, policy, you name it. They are experts in medicine and anything otherwise is just not true. And, you know, part of my job and what I'm here to do is make sure people know that. And, oh,

I have a PA that has an extensive ability in public health, whatever it is, whatever the area is, um there's a PA that can do that. So um the misconceptions, we just need to always continue to be putting forth what we can do. um And really, for me, the sky's the limit when it comes to PAs.

Eileen

Within the infrastructure of an organization, and I've been part of many, there is there' is there they're either looking for a nurse leader or a physician leader. There's no opening for a PA leader. And I went to the chief medical officer of one of the organizations I worked with, and I said, why is that? Why is there no opening for a PA to fill that role who's equally as talented, equally knowledgeable? Why is that a nurse or a doctor? Well, that's the way it's always been.

I said, well, that's the way we need to change it. Always is is not always will be. And that's a tough one to get around. So that's just my very small ah observation from that.

Jennifer Orozco

Well, and so let me just say a lot of the roles that I've had have been non-PA related roles. People don't know what they don't know, right? So if No one tells them they could do it differently.   And maybe we shouldn't have to do that. But unless you say, have you thought about this, or have you thought about opening it up, they're not going to.  So you know part of our job and our role in my mind is to help share that knowledge and help share what can be and the potential. And that has opened up roles in the organization: Directors of Advanced Practice, which is what happened in my institute, that didn't exist.  There wasn't such a thing. And and and then for a PA or NP to become the chief medical officer or the chief nursing officer, the chief operating officer, or the chief financial officer, people just leveraged tradition.

And so they didn't know how to think differently. Now, are there rules for certain things? Yes. And our job is to say, well, is that how it should be? And so those are all the complexities of health care that I think we need to continue to work through. We only harm ourselves. Even nursing is starting to back down to say, ooh, we kind of put ourselves, now we don't have a whole, we don't have enough nurses. How we gonna do that? And so we're starting to see some of that walk back. um And there's nothing that bothers me more, my work life, my professional life… When someone says to me, well, that's the way we've always done it.

Joshua

And let's let's be honest, how is that, and where has that gotten you?

Jennifer Orozco

Yep.

Eileen

Yeah, where's that relevant?

Joshua

It is insanity to keep doing something the way we've always done it if it's not working.

Eileen

Yeah. Yeah.

Jennifer Orozco

Correct.

Joshua

I think I'm mixing a couple of metaphors there.  Can you highlight some of the things that the AAPA is working on at a federal level, such as the work to remove restrictions on PA practice for patients receiving Medicare?

Jennifer Orozco

Yeah. I mean, we, you know, our approach at both the federal and the state level is different, right? Because, oh you know, from a federal perspective, you have to think about what you have the ability to do. I think a lot of what we do at the federal level is around um payer and CMS and as well as all of the other federal agencies. So whether it's HHS or CDC or you know the FDA, you know our job is to try to make sure that the PA voice is there and to be pushing for parity, right? I'll tell you, there's a lot of focus on equal reimbursement for healthcare.  And what does that mean?

When we're providing that care, as well as making sure that PAs are and their employers are reimbursed for the work that they're doing. And so making sure that if laws are changed, or we need to change it, um and that there's no arbitrary restrictions in place that again, prohibit what a PA can and cannot do. And some of these And we know how hard it is to change legislation at the federal level, right?

Jennifer Orozco

We know the challenges in Congress right now. And that's, I mean, that's just realistic here.

Joshua

I tried. I tried.

Jennifer Orozco

So we're continuing to push where we can.   Telemedicine is also a big push. You know, we just saw, I don't know if you saw the announcement from the DEA um just this past week around extending the telehealth flexibilities for virtual telemedicine care through 2025 so we can figure out and come to an agreement on what it looks like. But that's where our federal team is constantly on the hill, having conversations on both sides, building relationships and making sure that PAs are always thought of anytime we're introducing any kind of legislation at the federal level.

Joshua

And you touched on this a little bit earlier, but needs are very local for PAs. So what's true in Texas is different from what's true in Washington or Maine, like the need for air conditioners.

What does the AAPA do differently to support PAs in states with fairly severe practice restrictions, such as being unable to prescribe stimulants or other controlled medicine?

Jennifer Orozco

Yeah. Well, I'll tell you this, our state team… 's an amazing team. So our Chief Advocacy Officer, our Chief of Public Affairs, Chantal Taylor, is new um and has brought a breath of fresh air and experience to the academy and again under that bold… how to think differently… and where are we going from all different angles. And she has our state team, our federal team, and our policy, our professional reimbursement and policy team. And, you know, I'll tell you, the experience and the depth on her state team is tremendous. And so they partner .  Her directors partner with each one of the states to make sure they have what they need, the knowledge, data, resources. We have a communications team and help to prioritize, right? And so there are 50 states and we all have different needs, but our we're we always have a pulse on what's going on in the states, how we can help. Do we have a policy? Do we need to create a new policy to help these states where we can continue to utilize our voice if needed and insert ourselves… bring in, you know, president Priviledge or myself to have conversations and to really drive that change. You know, there's a lot of complex issues going on right now, especially in women's health. You mentioned transgender care, um all of these types of things. And so we're always doing assessments looking at state law, looking where there's an opportunity with regulations, and looking who we partner with because we can't just do it alone. So are we partnering with people who also can have some influence in the space that understand the changes that we need to make? So um it's a great team. They're always there. You can call me. You can call them.  But they're always happy to have conversations about what states need and or any of our specialty orgs or anyone um at the Academy.

Joshua

I hear an underlying theme here that you haven't touched on, but it just leaks out through the subtext. There is this tone of hopefulness that AAPA is trying to inspire and sort of the art of the possible, and it is profound, and I think our listeners should hear that.

Jennifer Orozco

Absolutely. I mean, it's you know it's where we want to go. We know that we have to change. And I think we're trying to break that mold, that tradition of this is the way it has to be, and this is the way we've always done it.   And we we want to drive change in so many places. And I want PAs to understand that they can lead these efforts.   Stop waiting for permission.

Joshua

Yes!

Jennifer Orozco

Start doing and start acting and stop …  cowering is not the word I want to use…  but make an effort and stop accepting what you think.

Joshua

Groveling.

Eileen

being too cautious, cautious, being too cautious.

Jennifer Orozco

… what you think it should be or what somebody told you and start doing and changing. Use me as an example, right? Things didn't exist. We didn't have structures for PAs and NPs. We didn't have policy. We didn't have any of these things, but I asked and I talked to people and we moved the needle and I couldn't do it by myself. If you think it's just you, but you can have conversations with others who will listen…. You build that relationship and that rapport and it and it will come. But PAs need to start understanding if they don't. And we have a great group who does. But I think these, especially this new generation, you guys will lead healthcare.   You have the ability to do it, take it and run with it and do it.

Joshua

And oh my God, they're awesome. The student energy, it's untapped power.

Jennifer Orozco

Yes.

Joshua

I love them. It's probably one of my favorite parts of being president right now is harnessing those students who are amazing and even seeing that at the national level.

Jennifer Orozco

Yeah.

Eileen

We're going to shift a little bit to the title change. Let's talk about that.   The AAPA HOD said, yeah, we're going to go to physician associate after a lot of money and a lot of discussion. So what is your hope for it in the coming years? Do you think, first of all, let me ask you this. Do you think it makes a difference to patients? Do you think it makes a difference to organizations that I am called a physician associate or a physician assistant? Do you think that matters?

Jennifer Orozco

100% makes a difference. 100%, 150, 200%, whatever number you want to throw on it, um it makes a difference. And I've seen it more times than I can count, especially at the policymaker standpoint, and especially when we're talking to corporations and others, and especially to patients. I mean, the research that we did and demonstrates that pa's or um that patients get confused, and that's true.  And there's no reason, um first of all, We have physician associates, and that's how we started as a profession for those who don't know that.   And there are still physician associate programs.   Those physician associate programs sit and take the board exam and graduate.  So there's a lot of misconceptions. And you know again, health care has changed since the 1960s.

And what happens? I can't go back there. That's what happened back then. But now with health care, and where we're going, it's important that we push to to move forward with title change.

Eileen

Thank you.

Jennifer Orozco

We are already doing that high quality work. We do not assist physicians or assist others, and it better represents who we are. So go forth, change the names of your businesses, of your state organizations, of your PA programs, um your state legislation, go forth and do um And it'll take time. There's no doubt. I mean, we're not the first people to do this. I hope everybody understands that. i don't (think this is) unique to the PA profession. Many other professions have changed their name over time or changed their title. A title is just a title. um and so But for us, this better represents more accurately who we are, what we do, um and helps build trust in the community. And It really does make a difference. So I don't know, remember I just said stop waiting for permission to do things. right Well, if you need permission, here's my permission. Work with your chapters, work with whatever you need to do. Changing the business name, super simple. You don't need legislation to change any sort of business name or others. You can use it in the media and you have to follow state law and know your policy, your regulations, and advertising. There's a lot of disclaimers.

Jennifer Orozco

So making sure you're not falsely representing yourself, especially when it comes to face to face, you know, meeting with patients. Um, but I introduced myself as a physician associate. I've done media interviews with physician associate. We obviously changed the academy name. The foundation is the physician associate foundation. I mean, um, these are all okay things. Uh, I lecture, I say physician associate. So.   It's OK. We have to work on the rest. And everybody's going to have a little nuance, depending on their state law and their policies and procedures that they have. And you have to know that. So you've got to do the work there.

Eileen

Yeah, we would have to, I mean, in Washington, we have to go, we have to change it at the legislative ah level, because all the laws are written as a physician assistant, and we'll have all that language after we change the physician associate.  And I am sure that it will spark some opposition from the state medical association when we say we are a physician associate, and that's to be expected.

I don't think that's unavoidable. um but when I graduated from University of Oklahoma in 1984, my diploma says, physician associate. It does not say physician assistant, it says Bachelor of Science and physician associate. And that's what I mean.  And for me to demean myself and say I'm a physician assistant, so I just say PA because I don't do it anyway.

Jennifer Orozco

yeah

Joshua

And for about like six years, seven years in the 70s, the AAPA was actually the American Academy of Physician Associates. So it's not without precedent. What is next for AAPAs legislative agenda?  You've worked on optimal team practice. You've worked on the PA compact. You've done tons of stuff.  What's cooking?

Jennifer Orozco

Yeah. Well, I think so much is cooking, right? I think we're moving at an exponential speed and trying to prioritize and balance all of that. I mean, we have a lot of states that we have to move forward in. There's a lot of state and state law just in general from a PA profession standpoint, right? So all that you mentioned, optimal team practice environment, title change, compact. We still have a long way to go in those states.

But then there's the whole payer side and the whole ah from the state or the regional perspective as well as the federal perspective and making sure that all of that is updated and changed.

Jennifer Orozco

And then there's everything that's moving quickly, right? All the work with AI, all the work with telemedicine, um all the work when it comes to and any kind of specialty, um you know, whether it's prescription drugs or therapeutic areas, whatever it is, um there's a lot to be done. And I think we have an opportunity to do it faster. And how do we continue to drive up support of the PA profession? you know there is This is where we really need our states to also partner with us, right? We know the states are small and mighty, depending on what state that you're in.

But making sure that all of our PA programs and our educators are speaking the PA language and that we're using forward language and that we're teaching the next generation of students what they're facing and what we're doing.

Joshua

That's better.

27:47.58

Jennifer Orozco

They're joining their state chapters. They're joining the AAPA. All will be essential to moving forward with the big legislative efforts that we continue to have… and I think um we're ready. I think PAs are ready. And my hope is that the younger generation of PAs realize that they need to come out as advocates of this profession and advocate for patients the moment they step into PA school and then the moment that they step out what that means for them in their profession.  And and we have to do a better job there. And yeah.

Joshua

And i I give that lecture actually at the program in Seattle with the University of Washington, because I think it's important and it works. It works.

Jennifer Orozco

Yep.

Joshua

As we wrap up, um do you have any final thoughts that our physician associate listeners across the country and even internationally should know about it being a PA or about the AAPA or even just words of encouragement for them?

Jennifer Orozco

Yeah. I mean, I think it's an amazing time to be a PA. I think you've entered a profession that is really thinking about doing medicine differently and really transforming healthcare. care That's what the AAPA is about.

We're here to offer resources, not only from your career and help you along the way, whether it's leadership path, research path, education path, you name it, we're here to support you, but also our advocacy efforts are big and they're bold. And not only for the profession, but for patients and our goals towards health equity as an organization. And so the more we can do that together with our state chapters, supporting your state chapter, supporting your um you know the national organization, the AAPA, the more we can get done. um And the more we're united saying the same thing and using our voice to talk about how important title changes physician associate, how important

….to remove every barrier to PA practice that exists in this country. How important that is for an optimal team practice environment. and how important it is that we allow PAs to become leaders and executives in healthcare systems and to lead healthcare care change. And who better than a clinician with experience in every part of the world, every part of every specialty, every setting, there's a PA that exists and I really want to see us step up and really lead the future of healthcare care and where it's going. I know we can. I want people to believe that they can. I can't tell you. I can only show you that path. You guys gotta walk it. um I'll help along the way in whatever guidance and we have a great generation of PAs who I think can also offer guidance along that way, um but we all have to be rowing in the same direction. so I'm excited about it. um And you know I'm looking forward to really seeing what the future brings for PAs and for all of health care.

Joshua

Well, I will say just in our own conversations and getting to know you over the last couple of years, you've already been a wonderful strategic mentor and support. And I know you're passing that on to other people as well.

Jennifer Orozco

Thank you, Joshua.

Eileen

Yeah. Well, you know, in 40 years of being a PA, I've seen a lot of change, where we were employed, couldn't write a prescription. You know, we've come a long way. And I can tell you from where I sit right now, it is a very, very exciting time for PAs. I have never seen so many opportunities for PAs to be in leadership and to make a difference. And I am envious of that now, where I didn't have that opportunity. But I strove to put ourselves out there in my 40-year career and I think I did okay. um So I agree with you, Janet. It's very, very, very exciting and and it gives me great heart and hope when I see leaders like you and Josh and and and coming up and saying, look, this is who we are. Let's make a difference and let's get out there and take care of the patients because that is number one. That's what we need to do.

Jennifer Orozco

Absolutely.

Eileen

Thank you for being here today. Jen, you've been just a beacon of light and hoping to truly appreciate your passion and your profession, your leadership. You are a shining example to all of us. So thank you so much. In the meantime, if you have questions about PA practice leadership or legislation, you have an idea about a podcast, please let us know at paplaybook@gmail.com. We also have a website, thePAplaybook.com.   Look for us there as well. So we'd love to talk to you some more. Let us know if you have any ideas. And we can't wait to hear from you.

Joshua

And like I say, every time ,word of mouth is the strongest way to get the word out about The PA Playbook podcast. We're on Spotify. We're on Apple. If y'all can do us a favor, follow our podcasts, rate our podcasts, please. Nicely five stars. It would be nice. Um, subscribe, tell your friends who don't know about our podcasts. We can grow our audience. And if you know a PA or someone who loves PAs who would want to hear us, let them know about the PA playbook.

Eileen

So we're coming into the end of our first year at the PA Playbook Podcast and Josh and I are really excited to start our second year. We got some great topics coming up. So thank you for joining us today for our 10th and final episode of the season. And we've got a new season coming up. So stay tuned. It's gonna be good.