Latest / Becker’s Healthcare Podcast / The Expanding Role of Physician Assistants at Mount Sinai with Heather Isola

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The Expanding Role of Physician Assistants at Mount Sinai with Heather Isola · Becker’s Healthcare Podcast

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  Every year, Becker's annual meeting brings health care
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  leaders together to unpack the most pressing issues
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  facing the industry.
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  And every year, those conversations shift in profound
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  and unexpected ways.
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  This April, more than 3,500
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  healthcare executives will return to Chicago
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  for Becker's sixteenth annual meeting.
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  Seven ninety five elite speakers will offer new
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  lessons, new case studies, and predictions about what
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  comes next.
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  Join us April 13 through the sixteenth.
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  For the agenda and event details, visit beckershospitalreview.com
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  and click on the events tab in the
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  upper right.
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  This is Scott Becker with the Beckers Health
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  Care podcast.
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  We're thrilled to be joined by somebody who
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  is at both a brilliant leader herself
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  and at a magnificent health system,
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  running and driving one of the most important
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  areas in health care today.
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  We're joined today by Heather Esola,
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  and Heather is the vice president
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  of physician assistant services at Mount Sinai Health
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  System.
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  Heather, we'll talk today about the role of
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  physician
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  assistants, the growth of importance in this in
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  our in our daunting health care supply and
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  demand environment,
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  and a lot more. Can you take a
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  moment and introduce yourself and tell us a
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  bit about yourself and your career and also
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  about Mount Sinai Health System, which really needs
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  no introduction, but tell us a little bit
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  about both. Yeah. Well, thank you for having
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  me. It's wonderful to be able to speak
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  about this topic
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  and how it interrelates into our larger ecosystems
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  of health care. I think we all have
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  to be thinking about that now going forward.
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  As far as me, my history,
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  I started out
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  about twenty years ago now in community medicine.
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  I did HIV and hepatitis c work, when
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  I came fresh out of school,
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  and then found a liking towards women's health
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  through that. I joined Mount Sinai Health System
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  and their OB GYN department
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  couple years into my career and have stayed
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  ever since. I've been moving and grooving through
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  the health system in different roles and different
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  leadership positions, all while really supporting the work
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  of advanced practice
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  providers, specifically for PAs under me,
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  and,
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  was the first,
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  director of PA services for the health system,
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  inaugural position.
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  COVID happened
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  that really elevated the role of having,
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  PAs and NPs in executive roles to help
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  system management orientation,
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  strategy operations, and since then,
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  has really blossomed into what we have now
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  as a center for advanced practice providers
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  and everything that follows underneath that for strategy
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  operations, retention. You name it, we do it
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  for advanced practice providers.
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  And talk about the evolution from being a
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  physician assistant yourself
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  to to now sort of vice president of
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  physician assistant services
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  in that that development. I know you've also
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  gone back to do an MBA,
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  constant self improvement and learning. But talk about
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  that movement from practicing
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  to leading
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  and some of the evolution in that for
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  yourself.
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  Sure.
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  I was always a doer,
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  and I always knew I wanted to be
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  a PA, and that was abnormal
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  twenty
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  some now, you know, more than that, twenty
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  five, thirty years ago.
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  Not many people were going into the workforce
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  as wanting to be a PA.
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  So coming out, I knew my place, but
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  then I was always interested in how something
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  works
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  and how practices work and how all of
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  the staff are interrelated.
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  So very early when I was even in
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  community medicine, I was doing the interdisciplinary
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  workshops. I was doing community teaching.
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  It was being a provider, but then also
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  being involved in all these other systems and
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  operations that make health care tick.
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  When I moved into Mount Sinai Health System,
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  I really got a feel for the academic
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  health center,
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  all the layers that are within it and
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  was really intrigued by all of it. So
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  centric care, but in order to have
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  great patient care delivery,
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  there's about 70 other processes that have to
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  happen before you see a patient,
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  and I loved
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  figuring that all out. So,
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  it started very simply on the floors of
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  doing, like, throughput and policy management
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  and just really pet projects that I took
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  a liking to and wanted to get done
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  for the betterment of the practice,
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  which led into me becoming the clinical director
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  for OB GYN,
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  at our Mount Sinai Hospital campus.
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  And then that led into me saying, hey.
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  There's gotta be
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  more than this for other APPs.
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  A lot of APPs have this,
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  ability to see the the things that we're
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  doing in health care above and below and
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  to the sides.
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  We're a great middleman. We see everything.
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  So that makes us great at strategy and
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  operations.
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  So I took that and brought that to
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  the health system
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  and really proposed
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  way back this is back in 2016.
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  Listen. We can really do something with this
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  large workforce. I don't even know how many
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  there are of us here. That's one problem.
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  So maybe we should figure that out, and
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  maybe we should see
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  how we can
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  emphasize,
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  grow,
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  and use this workforce
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  to the ability instead of having it siloed
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  in all these departments under individual physicians.
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  And that was really the going rate and
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  then when COVID happened
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  there was an absolute need because now you
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  needed to move an entire workforce
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  and the beauty of having NPs and PAs
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  is the general boarding.
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  So they're not specialty specific. So now you
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  have this
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  movement of workforce that answers disruption.
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  So if we needed that, we still need
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  it to this day.
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  Just
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  a fantastic, and what a fantastic career, Heather,
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  in perspective.
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  The the the future going forward,
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  projections show we're already
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  incredibly short of primary care physicians.
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  We're developing nurses in PAs at a much
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  better rate than we are physicians.
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  What does the future of primary care look
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  like?
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  Is it likely to be
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  a a large percentage
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  conducted by PAs?
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  And, I mean, we're already seeing a ton
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  of that. What do we have to do
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  to make sure that that goes great?
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  Any thoughts on the future of primary care?
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  Is it PA driven, MP driven versus doctor
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  driven?
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  Is it a mix of those?
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  And what do we have to do to
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  make sure it goes
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  great? Yeah. I think it's a true collaborative
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  model.
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  You
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  don't have excellence of care unless you have
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  physicians.
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  Right? And
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  PAAs and NPs will take their charge from
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  physician leadership.
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  And it also goes state by state. So
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  every state is
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  is going to think of these rules differently.
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  So in New York where we are, we
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  have a lot of full practice ability. So
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  NPs can open their own practices. So that's
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  one thing. But other states, that's not true.
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  So it really is gonna be a state
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  by state answer.
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  But, generally,
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  team based practice is where it's gonna be.
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  If you have
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  a physician
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  and an NP and a PA or a
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  physician and two PAs, however you make up
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  that model,
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  those three people
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  can take care of 10 times the amount
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  of people if just one of them did.
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  So really taking care of a population within
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  a practice.
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  And then
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  the answer everyone loves giving is top of
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  licensed care, but
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  that's a very easy thing to say. It's
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  a really hard thing to do in practice.
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  So are they seeing patients independently?
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  Do they have their own schedules?
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  Do they have the similar medical staff privileges
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  as your physicians do in their scope of
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  practice
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  so they can do everything
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  that they're able to and competent for.
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  And then are we measuring it? Are we
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  measuring the right things? It's not just revenue.
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  It could just be that, you know, we're
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  improving our throughput. We have better patient retention.
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  There's all these knock on effects that I
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  think people skim over, but what APPs are
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  really good at. They're getting the patients in.
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  They're improving the patient experience.
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  They're keeping the longevity of the practice. They
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  hold up the volume.
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  It really is a collaborative sport, and I
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  think we just all need to move in
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  that direction to efficiently
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  care for a large population. There's not enough
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  of us.
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  No. I think that's exactly right, and the
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  supply and demand issues are daunting. And I
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  love what you said about top of license.
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  Yes. It's very important, but it's simple to
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  stay, and there's a lot more to it
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  than that.
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  Just like physicians, PAs, there's different state rules.
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  There's different qualifications for different people depending on
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  how great they are, what they do, and
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  what does that mean in terms of top
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  of license and so forth.
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  How is PA
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  it seems like
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  when I have a PA for my treatment
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  today,
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  when I go to urgent care, I go
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  to the doctor, I go to the orthopedic,
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  it seems today that the category of PAs
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  that I am seeing
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  seem really well trained,
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  and and and really productive and really helpful.
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  What does it take to make that consistent
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  throughout the universe
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  to where I mean, physician quality is, of
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  course,
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  like any professional quality, it depends on the
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  day and is all over the board. Some
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  are fantastic. Some are okay. The same with
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  podcasters, lawyers, publishers, any business you're in. Some
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  are great, some are not.
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  How do you
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  I'm having great experience with the PAZDC. I
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  quite frankly have great experience with the doctors
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  I see too. But but how do we
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  make that more standardized and more uniform? Is
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  there is there a
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  a thought on that?
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  I think some of this is in the
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  way
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  we're trained,
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  and the the programs
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  that are in existence today do a very
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  good job of
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  making sure
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  the PAs and the NPs that are graduating
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  are clinically competent
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  and in a place where they have a
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  great starting point for day one on the
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  job.
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  But from that point on, it really
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  is the work of the practice, the physicians,
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  the institutions,
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  the systems that they're part of to
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  really do what a lot of people call
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  as transition to practice.
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  And that transition to practice, those first two,
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  three years that someone is out and working,
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  because we don't have residency,
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  those are our most moldable times. So all
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  of the good behaviors of
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  patient experience,
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  bedside care,
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  how you care for patients,
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  how you're critically thinking,
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  how you're putting those differential diagnoses, and then
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  how you tie it into everything is all
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  around how supportive of a work environment you're
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  in.
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  So as more institutions and more practices
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  embrace EPPs, it does have to come with
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  a level
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  of systems, processes, educations
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  to support that workforce.
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  So you'll get a good PA or NP
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  if they're well supported, well educated,
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  have access to CME,
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  have, you know, a great ability with their
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  HR, and they feel like
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  they're in a good position. It's it's all
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  of those things that make an employee shine.
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  Right? And then that translates
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  to great patient care. So it's a very
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  complex answer, but it really is about
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  embracing the profession,
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  knowing specifically
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  what the job description is, and then supporting
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  that job description in whatever way the system
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  and then supporting that job description in whatever
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  way the system can.
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  Fantastic. And and let me ask you one
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  more question,
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  before I let you go. Heather,
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  talk about this year, 2026.
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  What are you most focused and excited about
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  this year?
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  I am most excited about fine tuning
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  that top of license answer. We've started to
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  dabble with it in the last year, but
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  on a very large scale, so we're talking
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  about seven hospitals and and all of their
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  faculty practices and ambulatory practices,
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  how can we make
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  this workforce and other workforces
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  be the most efficient and sustainable
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  for our changing health care. And I think
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  we're really breaking into that. So
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  what are the things that are the items
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  and goals and our balanced scorecard of the
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  health system that are reflected
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  in the APP workforce. And I don't think
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  a lot of people have done that on
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  a such a large scale. So I'm really
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  excited to break into that and
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  come up with
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  a play book, really,
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  of how to do this APP workforce
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  in a way that it's going to answer
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  our resiliency in health care and how we
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  can be innovative and then how can we
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  be efficient with the person power we have.
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  Thank you. No. I I I love that,
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  and and I quite frankly love your entire
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  career and career trajectory from PA
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  to leadership
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  to to just a broad thinker on all
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  these issues. It's really remarkable.
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  Thank you. Heather,
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  it it it really is. I I I
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  wanna thank you for joining us on the
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  Becker's HealthCare podcast today.
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  Truly, you've you you you're in one of
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  those roles, and you're one of those people
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  that that's really one of the solutions to
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  where health care is going and where it
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  has to go. So thank you for all
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  you do, and thank you for joining us.
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  Thank you. Appreciate it. Thanks for having me.