1 Joint Task Force on the Future of the PA Workforce Session I January 20-22, 2011 JW Marriott – Washington DC

2 Session Overview The charge of the task force is to develop recommendations which can be implemented by AAPA and PAEA for the growth of the PA workforce in a manner that maintains quality and assures the profession’s maximum impact on the health of the nation through In this first Design Session, participants explored scenarios of the future of the PA Profession, developed “wild innovations” to explore the implications of extreme cases, and developed a preliminary set of recommendations for the PA Profession. These preliminary recommendations will be developed in more detail during our next Design Session in April 2011.

3 Keynote Speaker

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5 Variables for the Future - Assignment Humans have an abysmal track record at predicting the future. So instead, let us imagine futures that are possible. Part I In groups of three, your challenge is to identify four (4) variables, forces or factors that are extremely IMPORTANT for the PA Profession in 2020 and also extremely UNCERTAIN. “The aging of the population” may be very important for the PA Profession, but it is almost a certainty, so this kind of variable should not be included in your list. “My breakfast on January 20, 2020” is highly uncertain, but not very important (I’m sorry) “Federal Funding for PA Clinical Education” would seem to be both important AND uncertain. Part II Now, for each of your four variables, please define the two extreme endpoints. In the “Federal Funding for PA Clinical Education” example, the extremes might be “No Funding” and “Medicare Subsidies for Clinical Education”. Please write your list (legibly, if possible) on a posterboard provided.

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8 Session Overview

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10 Welcome and Introduction

11 Welcome and Introduction

12 Scenarios - Assignment Overview of the Scenario Process The purpose of scenarios is to engage you and your colleagues in a discussion about the emerging future of the world in which Physician Assistants will practice, and to think about how the PA Profession should respond to key forces and factors that are shaping the future. The method of these activities is for you to prepare alternative scenarios of the future, and then using these scenarios to think about appropriate responses. Assignment This is a small group activity. As you may recall from last night, we identified several key variables that are driving the future of the PA Profession. We identified variables that are both very important for the future of PA’s and very uncertain. Each team has been assigned a different pair of these variables. In this activity, please use these variables to explore possible futures for the PA Profession. Each of the four quadrants of the matrix represents a specific combination of two key variables, and implies a scenario that should be quite different from the others. 1) Discuss each quadrant of the matrix in turn. Give each quadrant a two or three sentence description and a catchy, descriptive title. 2) For each quadrant, list the implications for the PA Profession. What will be different for PA’s in each scenario? 3) Given these widely divergent futures, any and all assumptions and “sacred cows” should be challenged. What are the 2-3 most wildly innovative changes, initiatives, practice models, education models, etc that the PA Profession could undertake to radically transform itself?

13 Scenarios – Team 1

14 Scenarios – Team 2

15 Scenarios – Team 3

16 Scenarios – Team 4

17 Wild Innovations - Assignment Each team has selected a different Wild Innovation from the previous round. Your challenge in this round of work is to describe how this Wild Innovation happened. Assignment It is 2020 and your Wild Innovation has been Wildly Successful! The PAIA (Physician Assistant Innovation Association) has asked you to tell the story of your innovation for the “Innovations of the Decade” issue of its magazine. Draw a model of how your innovation works and describe the Big Idea Explain how this innovation impacts the healthcare system, society at large and the PA Profession Explain how this innovation grew over the last ten years – what were the biggest obstacles and how were they overcome? Prepare your story on the marker board. At the end of this round, you will share your story in the plenary. You have about 60 minutes to complete your work.

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19 Wild Innovations – Team 2

20 Wild Innovations – Team 3

21 Wild Innovations – Team 4

22 Innovations on the Continuum – Assignment Big innovations have big implications. We will explore how all phases of the development and practice of PAs have changed to enable your innovation. Assignment It is 2020 and your Wild Innovation has been a success. What changes, improvements and innovations have taken place in each phase of the PA Continuum of Competence to make your Wild Innovation possible? What has changed in: The Pre-PA Education Phase The Didactic Education Phase The Clinical Education Phase The Early Career Phase (0-6 years) The Mid- and Late-Career Phases (6+ years) Prepare your presentation on the marker board. In about 45 minutes, you will share your work with the other groups.

23 Innovations on the Continuum – Team 1

24 Innovations on the Continuum – Team 2

25 Innovations on the Continuum – Team 3

26 Innovations on the Continuum – Team 4

Stories – Assignment What does it mean for all of the stakeholders in the PA Profession for the number of practicing PAs to change? Each group in this round of work will explore a different story about the number of PAs and graduates in For your reference, today there are about 75,000 practicing PAs and about 5500 new graduates each year. To date, very few PAs have begun retiring. Team 1 – Rapid Expansion: 300,000 practicing PAs + 18,000 graduates per year Team 2 – Stay the Course: 150,000 practicing PAs + 5,500 graduates per year Team 3 – Contraction: 100,000 practicing PAs + 2,500 graduates per year Assume that the year is 2020, and your team’s scenario has happened. 1.How did this scenario happen? 2.What did the PA Profession DO to make this happen? 3.What did the PA Profession FAIL TO DO to make this happen? 4.What are the opportunities and challenges in this scenario? Please build your model of this scenario on your marker board. At the end of this round, you will share your work with the other groups. You have about 60 minutes to complete your work.

Stories – Team 1 (1 of 2)

Stories – Team 1 ( 2 of 2)

Stories – Team 2

Stories – Team 3

32 How Many PAs Do We Need? – Assignment We have explored a wide range of possible futures and innovations today. Our final question of the day is devastatingly simple. Teams 1 & 2: How many PAs SHOULD be in practice in 2020? Teams 3 & 4: How many PAs COULD be in practice in 2020? More important than your final answer is your thought process. As you develop a final number to propose, please record the process you used to create that result. What factors, facts, trends, and issues drove your design-making process? At the end of this round, you will share your work with the other groups. You have about 60 minutes to complete your work.

33 How Many PAs Do We Need? – Team 1

34 How Many PAs Do We Need? – Team 2

35 How Many PAs Do We Need? – Team 3

36 How Many PAs Do We Need? – Team

37 You, The Expert – Assignment This is an individual activity. Please find a poster board somewhere in the room, and write your name at the top. Assignment – 20 minutes You have heard from the experts – our keynote speaker, the pre-event webinars and interviews, and the professionals you work with every day. You have explored the future through a variety of filters yesterday. Now is your opportunity to list YOUR recommendations for the PA Profession. What recommendations do you have for the PA Profession across the continuum (from applicants to clinicians) to accomplish the following objectives: To ensure a diverse workforce To provide quality infrastructure for PA education programs To maximize the distribution of PAs across practice areas and geographies To ensure quality across the board Please describe these recommendations on the posterboard that you have selected. If possible, use models, diagrams, shapes, and colors to help illuminate your recommendations.

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39 You, The Expert

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50 Initial Recommendations – Assignment Now that you have heard the recommendations from the “experts”, your team is now being asked to develop an initial set of recommendations for a specific focus area. Team 1: How to Attract the Right Qualified Applicants Team 2: How to Ensure a Quality Educational Experience Team 3: How to Train in the Right Clinical Settings Team 4: How to Place PAs in the Right Settings Post-Graduation Part I: Brainstorm – 15 minutes List 20 or more recommendations for YOUR focus area to grow the PA profession, based on your individual work and the conversations you had yesterday. Part II: Prioritization – 30 minutes Discuss and decide what criteria you would use to prioritize the “most important” recommendations. List your criteria on the marker board. Finally, use those criteria to select your ten most important recommendations. Indicate on your marker board your Top Ten recommendations.

51 Initial Recommendations – Team 1

52 Initial Recommendations – Team 2

53 Initial Recommendations – Team 3

54 Initial Recommendations – Team 4

55 Initial Recommendations – Post-it Notes 1.Collaborate with local AHEC's (pipeline, strengthen) 2.Define Quality? What is a quality experience? 3.Create, Curricular, Criteria for Excellence in PA Education 4.Curriculum components on practice design and management 5.Expand/standardize advocacy and practice management education skill sets/competencies for PA Students 6.Add flexibility to didactic curriculum to respond to changing healthcare needs 7.Encourage student involvement in national leadership 8.Track for students to become involved in PA education 9.Use of alternate teaching strategies in didactic year or educational models & Data to assess outcomes standardization of peers (trouble reading that last word) 10.New instrumental formats 11.How to properly manage distributed education 12.Look at sequencing or timing of IPE courses and other non-sci courses in didactic year 13.Coordination and Interpretation of clinical training 14. Best practice models/Publish Re-entry/Team Based CME 15. Community business case for access to a PA 16. Partner with local workforce initiatives to promote rural practice opportunities 17. Support re-entry for PA's/Explore alternation CME (webinars) formats for remote/rural and other locations/Explore Team Based CME 18. Funding 19. Create financial incentives to encourage diverse groups of applicants and send them to communities of need 20. Good idea on the PA interactive guide/video game on the profession 21. Application forgiveness for minorities in those undeserved areas 22. National clearinghouse for displaced workers and vets to enter HC workforce/Career and Academic Counselors 23. Develop a coordinated initiated/campaign for key PA messaging concise, consistent and repeatable. 24. Career days with hands-on experiences 25. Consider broader message for entrance rather than just grades-(Health experience, distance traveled, underserved minority(?)) Between rounds participants left feedback for each group on post-it notes. Here is that feedback.

56 Recommendations and Questions – Assignment Now that you have seen the work of the other teams, and received input from the other teams, develop a list of “straw man” recommendations for your team’s focus area. Team 1: How to Attract the Right Qualified Applicants Team 2: How to Ensure a Quality Educational Experience Team 3: How to Train in the Right Clinical Settings Team 4: How to Place PAs in the Right Settings Post-Graduation For each of your recommendations, what questions do you have, and what work needs to be done by May 1 in order to make this recommendation concrete and actionable?

57 Recommendations and Questions – Team 1

58 Recommendations and Questions – Team 2

59 Recommendations and Questions – Team 3

60 Recommendations and Questions – Team 4

61 Recommendations and Questions – Team 5