In honor of National PA Week, Clinical Advisor is featuring PAs who are making a difference in the field. Today, we are highlighting AAPA President and Chair of the Board Jennifer M. Orozco, MMS, PA-C, DFAAPA, who is director of Advanced Practice Providers at Rush University Medical Center in Chicago and is an assistant professor in the Department of PA Studies at Rush University College of Health Sciences. Ms. Orozco has been practicing as a PA in vascular surgery for nearly 20 years and began her career in emergency medicine and internal medicine. Hear Ms. Orozco discuss her path to leadership, experiences during the COVID-19 pandemic, views on mentorship, AAPA presidency goals, tips for recent PA graduates, and insights on avoiding burnout in the videos and read her story below.
Q: What inspired you to become a leader in the PA field?
PA Orozco: It has been a journey. When I first started at Rush, I was one of approximately 20 advanced practice providers. As our numbers were growing, I started to run into a lot of barriers. Not only did people not know what my scope of practice was, but also patients didn’t know my role and we didn’t have hospital policy [on PAs’ roles]. We had no structure and organization, and so I was getting told “no” a lot. And for those who know me, I don’t like to be told no.
I started to branch out to seek answers. I got involved in my state chapter, the Illinois Academy of PAs, and sought out answers on state laws and policies. I know what I can do and what I’m trained to do, but I wasn’t being allowed to work to top of license. I partnered with several PAs across the organization as well as some APRNs who were having the same issues to say, “What do we need to do?” And so we organized. I started the first PA committee at Rush, getting my feet wet in a leadership position. That role evolved and I was asked to take over as director of clinical education [for the Rush Department of PA Studies] and started the PA program at Rush as the demand for advanced practice providers continued to grow.
There are now over 400 advanced practice providers at Rush. I was asked to step in about 6 years ago, as director of advanced practice and build the structure from the ground up to create something that was not only sustainable and gratifying for the advanced practice providers, but also for the institution financially and in terms of quality outcomes and patient care.
It was my partnership at the state level with legislators and state representatives that helped change PA practice legislation because there were a lot of things that are outdated because they were put in place early 1970s. Health care has changed so much and we needed to start having modernized health care policies.
Then I worked at the national level to say, “How can we do it better and who do we have as the voice of health care at the national level?” That is how I ended up joining AAPA, where I was inspired by others who are trying to make a difference for patients. And so here I am AAPA president 18 years later and very much enjoying what I’m doing.
Q: How can PAs get involved in health care legislation?
PA Orozco: Yes. You don’t have to be the president to be involved. Even having your voice be heard and seeking to understand legislation and regulations is important. Change is hard; it takes a long time to implement change and it can be frustrating. It really is a journey and even if you’re just chipping away little by little to make policy changes, it really does make a difference. I would encourage PAs to build your relationships, talk about what the issues are, and figure out how you can partner to drive the change as you move forward.
Q: During the COVID-19 pandemic, how did you help with Rush’s drive-through testing operations and provider redeployment efforts?
PA Orozco: I’m really lucky as director of advanced practice providers at Rush. My partners are at the executive level and, when COVID-19 hit, we set up the Hospital Incident Command Center and I was asked as a leader of the organization to take over directing and facilitating testing operations across the entire system as well as provider redeployment. At the height of the COVID-19 pandemic, our ICUs, emergency department, and hospitalist team were overwhelmed and surgeries weren’t happening.
This is where APPs really shined. PAs’ education and training is a generalist model, which allowed me to take PAs who worked in surgery and put them in the ICU. They had the skills and ability to take care of those patients.
Although it was really rewarding, mentally it was very much a challenge. We were taking physicians, PAs, and APRNs from their homes and families and putting them in the ICU with COVID-19. I think all of those teams came together and realized how much they value each other in health care and how much they contribute when they all work together.
Testing is still continuing and the Hospital Incident Command Center is still going because of COVID-19. It is important that we are still focused on making sure everybody is safe and able to care for patients.
Q: Do you have any advice on managing burnout and fatigue among PAs and other clinicians?
PA Orozco: We’ve seen an uptick in anxiety, depression, and substance use disorders not only in the general population but also among health care providers. The Kaiser Family Foundation recently published a report showing that about 4 in 10 adults have reported symptoms of anxiety or depressive disorder. It used to be 1 in 10, now it is 4 in 10 postpandemic. That is a huge increase. I have also seen firsthand the effects of mental health. I have many colleagues who have decided to leave medicine altogether because of the stress that they endured during the COVID-19 pandemic. We know colleagues who are no longer here because of it and succumbed in the most awful way to their mental health issues.
I have made it a priority to speak about the challenges and stigma around mental health not only for patients, but also for health care professionals. This is not something clinicians often talk about for fear that they would be stigmatized. My hope is that as we talk about it more, people will get the help that they need because you can still be successful and have anxiety and depression. We all have these disorders in some way, shape, or form. My goal as AAPA president is to bring awareness around mental health and destigmatize what it has done in this country and across the world so we can prevent poor outcomes.
Q: What are your other goals for your AAPA presidency?
PA Orozco: There are so many. First and foremost, my goal is to improve and expand patient access to care. PAs are highly trained health care providers and undergo over 2000 to 3000 hours of clinical rotation training during PA school. They are poised to deliver high-quality health care and are committed to team-based medical care. That has been the core of who we are since the beginning and it is why I became a PA. We have made it our mission to improve access and keep patients at the forefront.
Improving access to care is challenged in many ways; so many patients lack primary care providers and yet PAs are primary care providers. Thus, one of my other priorities as AAPA president is removing barriers to PA practice. During the pandemic, executive orders issued by governors in 21 states removed all barriers to PA practice.
Thus, in a health care emergency, we removed all those barriers because we had these health care providers who provide excellent care wherever they were needed. What we found was high-quality outcomes and improvement of health. This showed how flexible the PA profession is and how skilled PAs are in providing care. Thus, we have to remove barriers so that PAs can provide this level of care all the time, not just in times of crisis. We have to remove the archaic barriers that haven’t caught up with modern health care. I am going to continue to push for change that allows PAs to provide high-quality, cost-effective care to patients.
Q: If you could go back in time to when you graduated from your PA program, what would you like to tell yourself?
PA Orozco: I would say give yourself a little love early on because you can’t know everything. That is why we partner and collaborate with others as PAs. And I would say you have to listen to your patients. It is the most important thing. You can’t tell them what to do. You have to listen to where they’re coming from and seek to understand them. That will go a long way in your practice.
I think the biggest thing is that health care is changing and it changed so much faster than I thought it was going to. We’re a little bit rigid sometimes; we follow rules and we stick to what we know. You have to be able to evolve as a PA. How your practice looks when you graduate is going to be very different 20 years from now. There are so many good things [to come] and you just have to be willing to kind of accept them and continue to change so that patients stay at your forefront. At the end of the day, that is what it is about. It is about the patients and providing that high-quality care.
Q: How important is mentorship for PAs at every stage of their career?
PA Orozco: It is so important. I have had so many mentors over the years. I had a mentor, her name is Josanne Pagel, MPAS, PA-C, MDiv, DFAAPA. She is a former AAPA president and is executive director of PA Services at the Cleveland Clinic. She has been a mentor for me for many years and was a trailblazer for PAs. She is one of the first, if not the first, executive-level PA and showed me that you have to be bold, you have to go forward, and you have to do what you need to do for the good of the patients. She has created structures and systems that have been very sustainable and successful. She has also told me about not reinventing the wheel. She shared everything, her knowledge, her documents, whatever it was. She handed them to the next PA and said, “Go forth, you can’t copy, but go forth and use this.” And I have done that in my career. So people will call me from all over saying, “I’m starting a PA program or I’m starting this,” and I’d say, “Here, don’t reinvent the wheel. Take what I’ve learned.” And that’s really what true mentorship is – fostering someone’s growth.
You can’t know everything when you come out of PA school. Find where your strengths are and try to lead in that direction as best as you can. Some people, their job is clinical 100% all the way. And then there are people like me who go more into administration and leadership roles; that was my strength as a PA.
How can I help bring that out of people? Figure out what you want. How do I foster to get you to the next level? I’ve talked to a couple of my APPs at Rush and I say to them, “I see big things for you. And if it’s not here at Rush, I want to help you get there. And wherever that is, how do I get you there? And so I want you to stay here with me, but I really also want you to be successful in your career.” Josanne and so many others did that for me, and I hope to give that back as I continue.
Q: Is there anything else you would like to tell our readers?
PA Orozco: I would say that my biggest thing is that PAs are often misunderstood. Our name is a misnomer and people get very confused about what our role is. We have some of the most rigorous medical education and training that’s out there. I want patients to know that and I want other health care providers to know that. I think that PAs are the answer to many of our health care issues across the world. I see my colleagues doing it every day. They are smart people, way smarter than me, and I want to give them the ability to [practice to the full extent of their education and experience] because everybody deserves the right to high-quality health care.