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Speaker 1: This is Scott Becker with the Beckers Health Care podcast. We're thrilled to be joined by somebody who is at both a brilliant leader herself and at a magnificent health system, running and driving one of the most important areas in health care today. We're joined today by Heather Esola, and Heather is the vice president of physician assistant services at Mount Sinai Health System. Heather, we'll talk today about the role of physician assistants, the growth of importance in this in our in our daunting health care supply and demand environment, and a lot more. Can you take a moment and introduce yourself and tell us a bit about yourself and your career and also about Mount Sinai Health System, which really needs no introduction, but tell us a little bit about

Speaker 2: both. Yeah. Well, thank you for having me. It's wonderful to be able to speak about this topic and how it interrelates into our larger ecosystems of health care. I think we all have to be thinking about that now going forward.

As far as me, my history, I started out about twenty years ago now in community medicine. I did HIV and hepatitis c work, when I came fresh out of school, and then found a liking towards women's health through that. I joined Mount Sinai Health System and their OB GYN department couple years into my career and have stayed ever since. I've been moving and grooving through the health system in different roles and different leadership positions, all while really supporting the work of advanced practice providers, specifically for PAs under me, and, was the first, director of PA services for the health system, inaugural position. COVID happened that really elevated the role of having, PAs and NPs in executive roles to help system management orientation, strategy operations, and since then, has really blossomed into what we have now as a center for advanced practice providers and everything that follows underneath that for strategy operations, retention.

You name it, we do it for advanced practice providers.

Speaker 1: And talk about the evolution from being a physician assistant yourself to to now sort of vice president of physician assistant services in that that development. I know you've also gone back to do an MBA, constant self improvement and learning. But talk about that movement from practicing to leading and some of the evolution in that for yourself.

Speaker 2: Sure. I was always a doer, and I always knew I wanted to be a PA, and that was abnormal twenty some now, you know, more than that, twenty five, thirty years ago. Not many people were going into the workforce as wanting to be a PA. So coming out, I knew my place, but then I was always interested in how something works and how practices work and how all of the staff are interrelated. So very early when I was even in community medicine, I was doing the interdisciplinary workshops.

I was doing community teaching. It was being a provider, but then also being involved in all these other systems and operations that make health care tick. When I moved into Mount Sinai Health System, I really got a feel for the academic health center, all the layers that are within

Speaker 1: it and was really

Speaker 2: intrigued by all of it. So centric care, but in order to have great patient care delivery, there's about 70 other processes that have to happen before you see a patient, and I loved figuring that all out. So, it started very simply on the floors of doing, like, throughput and policy management and just really pet projects that I took a liking to and wanted to get done for the betterment of the practice, which led into me becoming the clinical director for OB GYN, at our Mount Sinai Hospital campus. And then that led into me saying, hey. There's gotta be more than this for other APPs.

A lot of APPs have this, ability to see the the things that we're doing in health care above and below and to the sides. We're a great middleman. We see everything. So that makes us great at strategy and operations. So I took that and brought that to the health system and really proposed way back this is back in 2016.

Listen. We can really do something with this large workforce. I don't even know how many there are of us here. That's one problem. So maybe we should figure that out, and maybe we should see how we can emphasize, grow, and use this workforce to the ability instead of having it siloed in all these departments under individual physicians.

And that was really the going rate and then when COVID happened there was an absolute need because now you needed to move an entire workforce and the beauty of having NPs and PAs is the general boarding. So they're not specialty specific. So now you have this movement of workforce that answers disruption. So if we needed that, we still need it to this day.

Speaker 1: Just a fantastic, and what a fantastic career, Heather, in perspective. The the the future going forward, projections show we're already incredibly short of primary care physicians. We're developing nurses in PAs at a much better rate than we are physicians. What does the future of primary care look like? Is it likely to be a a large percentage conducted by PAs?

And, I mean, we're already seeing a ton of that. What do we have to do to make sure that that goes great? Any thoughts on the future of primary care? Is it PA driven, MP driven versus doctor driven? Is it a mix of those?

And what do we have to do to make sure it goes

Speaker 2: great? Yeah. I think it's a true collaborative model. You don't have excellence of care unless you have physicians. Right?

And PAAs and NPs will take their charge from physician leadership. And it also goes state by state. So every state is is going to think of these rules differently. So in New York where we are, we have a lot of full practice ability. So NPs can open their own practices.

So that's one thing. But other states, that's not true. So it really is gonna be a state by state answer. But, generally, team based practice is where it's gonna be. If you have a physician and an NP and a PA or a physician and two PAs, however you make up that model, those three people can take care of 10 times the amount of people if just one of them did.

So really taking care of a population within a practice. And then the answer everyone loves giving is top of licensed care, but that's a very easy thing to say. It's a really hard thing to do in practice. So are they seeing patients independently? Do they have their own schedules?

Do they have the similar medical staff privileges as your physicians do in their scope of practice so they can do everything that they're able to and competent for. And then are we measuring it? Are we measuring the right things? It's not just revenue. It could just be that, you know, we're improving our throughput.

We have better patient retention. There's all these knock on effects that I think people skim over, but what APPs are really good at. They're getting the patients in. They're improving the patient experience. They're keeping the longevity of the practice.

They hold up the volume. It really is a collaborative sport, and I think we just all need to move in that direction to efficiently care for a large population. There's not enough of us.

Speaker 1: No. I think that's exactly right, and the supply and demand issues are daunting. And I love what you said about top of license. Yes. It's very important, but it's simple to stay, and there's a lot more to it than that.

Just like physicians, PAs, there's different state rules. There's different qualifications for different people depending on how great they are, what they do, and what does that mean in terms of top of license and so forth. How is PA it seems like when I have a PA for my treatment today, when I go to urgent care, I go to the doctor, I go to the orthopedic, it seems today that the category of PAs that I am seeing seem really well trained, and and and really productive and really helpful. What does it take to make that consistent throughout the universe to where I mean, physician quality is, of course, like any professional quality, it depends on the day and is all over the board. Some are fantastic.

Some are okay. The same with podcasters, lawyers, publishers, any business you're in. Some are great, some are not. How do you I'm having great experience with the PAZDC. I quite frankly have great experience with the doctors I see too.

But but how do we make that more standardized and more uniform? Is there is there a a thought on that?

Speaker 2: I think some of this is in the way we're trained, and the the programs that are in existence today do a very good job of making sure the PAs and the NPs that are graduating are clinically competent and in a place where they have a great starting point for day one on the job. But from that point on, it really is the work of the practice, the physicians, the institutions, the systems that they're part of to really do what a lot of people call as transition to practice. And that transition to practice, those first two, three years that someone is out and working, because we don't have residency, those are our most moldable times. So all of the good behaviors of patient experience, bedside care, how you care for patients, how you're critically thinking, how you're putting those differential diagnoses, and then how you tie it into everything is all around how supportive of a work environment you're in. So as more institutions and more practices embrace EPPs, it does have to come with a level of systems, processes, educations to support that workforce.

So you'll get a good PA or NP if they're well supported, well educated, have access to CME, have, you know, a great ability with their HR, and they feel like they're in a good position. It's it's all of those things that make an employee shine. Right? And then that translates to great patient care. So it's a very complex answer, but it really is about embracing the profession, knowing specifically what the job description is, and then supporting that job description in whatever way the system and then supporting that job description in whatever way the system can.

Speaker 1: Fantastic. And and let me ask you one more question, before I let you go. Heather, talk about this year, 2026. What are you most focused and excited about this year?

Speaker 2: I am most excited about fine tuning that top of license answer. We've started to dabble with it in the last year, but on a very large scale, so we're talking about seven hospitals and and all of their faculty practices and ambulatory practices, how can we make this workforce and other workforces be the most efficient and sustainable for our changing health care. And I think we're really breaking into that. So what are the things that are the items and goals and our balanced scorecard of the health system that are reflected in the APP workforce. And I don't think a lot of people have done that on a such a large scale.

So I'm really excited to break into that and come up with a play book, really, of how to do this APP workforce in a way that it's going to answer our resiliency in health care and how we can be innovative and then how can we be efficient with the person power we have.

Speaker 1: Thank you. No. I I I love that, and and I quite frankly love your entire career and career trajectory from PA to leadership to to just a broad thinker on all these issues. It's really remarkable. Thank you.

Heather, it it it really is. I I I wanna thank you for joining us on the Becker's HealthCare podcast today. Truly, you've you you you're in one of those roles, and you're one of those people that that's really one of the solutions to where health care is going and where it has to go. So thank you for all you do, and thank you for joining us.

Speaker 2: Thank you. Appreciate it. Thanks for having me.