Scenarios and Implications
Scenario Planning
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, 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 – Part 1
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 – Part 1
This is a small group activity.
Working with the sponsor team before the session, 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) Draw and label your matrix on a poster board.
2) Discuss each quadrant of the matrix in turn. Give each quadrant a two or three sentence description and a catchy, descriptive title.
3) For each quadrant, list the implications for the PA Profession. What will be different for PA’s in each scenario?
You have 45 minutes to complete Part 1 of this assignment. You will be given the next part of the assignment at that time.
Assignment – Part 2
Now, given these four possible futures and all of the different implications, what does it all mean for the PA Profession?
On your marker board, write a list of ideas, insights and recommendations for the PA Profession.
Here are some discussion questions to consider:
- What can the profession do to be better prepared for all these futures?
- What trends or data should the PA Profession keep an eye on?
You have 25 minutes to complete Part 2. You will present your work to other groups.
Short cuts to the result of each team's work: Team 1 | Team 2 | Team 3 | Team 4 | Team 5 | Team 6 | Team 7
Short cut to the discussion that followed: Discussion
Team 1 Walls and Poster
Team 1: Matt Dane Baker, Fred Sadler, Bob McNellis, Dana Sayre Stanhope, Ben Robinson, Michael Doll, Major Craig V. Paige
Team 2 Walls and Poster
Team 2: Geraldine "Polly" Bednash, Donna Sewell, Ayeshia Ellington Pompey, Susan Scott, Dee Schilling, Harry Pomeranz
Team 3 Walls
Team 3: Ann Davis, Brian A. Timm, Alfrede Provilus, Doug Wood, Dan Thibodeau, Trisha Harris-Odimgbe, Major Patrick Sherman
Team 4 Walls
Team 4: William "Bill" Kohlhepp, Justine Strand, Patricia Guerra, Patti Pagels, Steven Lane, Freddi Segal-Gidan, Felix Nwamaghinna
Team 5 Walls
Team 5: Cynthia B. Lord, Kristen Will, Rebecca Pinto, Maura Polansky, Doug Scott, Heather Trafton
Team 6 Walls
Team 6: Dawn Morton-Rias, Bill Leinweber, Kathleen O'Connell, James Brand, Lisa Alexander, Cheryl Holmes
Team 7 Walls
Team 7: Ted Ruback, Timi Agar Barwick, Pamela Donohue, Dan McNeill, Dick Knapp, John Houchins
Discussion
Jay: How was that? We asked you to look at 14 different variables [reads the list]. What did you hear in common?
Access to care. Preparation of the workforce for IT and EHR. Collaboration - whether it's with other professionals and other medical support folks (IT, clerical, etc.).
Data collection and research on things like job satisfaction. Dessimination of that information as well. Not just collecting it.
What kinds of research? How we are impacting variables in health care? Wellness, prevention, cost effectiveness - things like that.
A lot of groups said that diversity is a core value.
Team work and team training.
I saw a lot of primary care focus versus specialty care focus. The training might need to reflect early on where you are going instead of getting on the job training?
I saw this talked about at each station. The goal for a doctorate training probably would be a doctor of primary care. Primary care is a role that needs to be filled. I saw that a couple of places.
Skillsets - what skillsets do individuals need based on the area of expertise they choose to be in?
It was more about how we deliver education to students and to faculty. Training methodology and delivery systems (and content).
Access to care - if the variables change what does that mean? It certainly would increase access - more people utilizing services and more PAs would be needed. PAs need to be trained in more complex problems.
Inter-professional education.
Novel educational opportunities including clinical and non-clinical roles. We need some novel ways to do that. Things like being a manager or a faculty member is an example.
Primary versus specialty; a team based is wellness focused.
A greater partnership with the educational side and the greater community at large. Experiential learning. Connecting academia in to the clinical world and giving more experiential opportunities for learning.
Other clinical professions were talked about. The team approach. There was an interest in what other professions were doing. There was an interest in non-traditional health care practitioners as well.
Less or more access to health IT would introduce more people to the team.
Are there any striking differences? Generalists vs Specialists was a big question.
What are the big differences between the groups? One idea was to use the public dollars to provide funding to give back that tax money in primary care settings.
International dollars - maybe the money doesn't all come from here to develop educational programs?
PA education - is it separate from other groups is PA education as part of the greater health education system? Is it it's own thing or part of a larger system?
It seemed like the different groups that had variables with varying degrees of being out of our control. The ones where we had control seemed to suggest moving in a desired direction.
People didn't know what the reality is right now. We're really in between places and that is emblematic of a lot of problems. How will we know where we are going if we don't know where we are? That seemed to be driven by your perspective and/or a specialty.
Are we talking about proactive or reactive medica care? That conversation was driven by those that were involved in emergency medicine or those that are involved in primary care. The perspective changes based on practice. We know where specialty groups are going.
Quality - who's definition of quality will we use? What are the standards? The demand for PAs seemed to be in question. People went both ways. That may depend on the specialty.
In several groups every quadrant needed more PAs. Many people feel we need PA in primary care. We need more specialists. We need more faculty and researchers, etc.
We had health care costs as a variable - low and high costs. Is there lower costs because of more efficiency and more access to care? Or is it more expensive? One thing we discussed is something that is taking place right now. Where will it be in 10 years? We need to prepare for how health care will be delivered in 5 to 10 years from now.
The concept of building it and they will come - one day the pharmicists are registered pharmacists and the next day they were doctors of pharmacy. The reason we're not moving in the direction of primary care is that physicians aren't moving that way.
Our group looked at the patient perspective - what are they going to want when they are getting care? That flavored the conversation a little differently. High IT takes the need for the patient control away and their need to be more informed becomes less critical. They are the ones that are the care managers in the other scenario. It flavored the entire dialog.
What are the incentives to drop people into primary care and trying to solve that problem? That sounds like an open and large issue. We heard that the specialty would drive the doctorate and now we're hearing that primary care will drive it.
Next Assignment
We're going to explore the doctorate in a different way. We've divided you into new teams and you will learn a little bit about other professions and how they have developed a doctorate and then you are going to take that model and apply it to PAs.
Each team will do something different. We're wanting to better understand the challenge by doing a forced fit.
Two teams will have a slightly different assignment. Team six will synthesize the scenarios into some number that are interesting for the profession. Team five will explore the bridge idea that has come up. We're going to have a team build a model to see what it takes to make it work. This will take place over lunch.