Physicians assistants: Patient-ready on day one, but paperwork and AI rules still lag

Physician assistants say they feel highly prepared for patient care, but far less certain about the documentation burden and the fast-evolving rules around acceptable AI use, creating a new onboarding challenge for practice leaders.

Kelly Villella, director of medical education and medical practice at Wolters Kluwer Health, said that a survey of 203 practicing PAs found strong confidence in patient interaction but persistent gaps in documentation readiness and demand for more AI training, especially as practices work to define clear guardrails against “shadow AI.”

The following transcript has been edited for clarity and length.

Physicians Practice: All right, so let’s dig right into it. When you read this report, what felt most familiar, and what surprised you?

KV: Nothing was extremely shocking, but the results were a helpful reminder that physician associates are grappling with many of the same challenges as professionals across health care, and even other industries, during this technical revolution with AI. Physician associates expressed extreme confidence. What employee survey can any of us find where 96% feel really confident to interact with patients? There was also a lot of confidence on documentation, although about 20% did not feel as prepared when it came to documentation.

What is most interesting, and stands out but is not surprising, is that although their use of AI is growing, 87% still feel like they need more AI training. And I think that is true across a lot of health care and other professions. AI is changing so rapidly. People are trying to keep up. We chose to zero in on PAs specifically because it is one of the most rapidly growing health care provider professions, transforming health itself, while AI is also transforming health. So it is an interesting intersection we find in the survey.

Physicians Practice: OK, so we’re in the brave new world of AI being involved in everything. What’s changed most in the day-to-day reality of being a PA in the last few years?

KV: They mentioned in the survey that the top two things were dealing with insurance companies, which is an area we will need to dig into further. We did not get a lot of detail around that, although we all deal with insurance companies and can imagine what that must be like.

And then the use of AI tools. AI is around us, and every practice has not taken on AI officially into their technology. So people are grappling with what to use, what not to use, and acceptable use.

And then that documentation piece came up, both documentation and the intersection of AI to support documentation. That is an area they cited, and other surveys have also cited it as something AI could support. That is an area people feel less prepared. Documentation is tricky. It is important, but it also takes you away from face-to-face with the patient. AI might support making it more efficient and effective. Those are my connections from what I saw in the survey.

Physicians Practice: Our audience is mainly practice administrators, managers, leaders. When they’re bringing in new PAs, where do PAs tend to feel strongest on day one, and where do they need the most support?

KV: The survey was very clear that they feel completely prepared for patient interaction. I was pleased to see exactly what we know about this profession. They are trusted, highly trained, and patients can expect a really great experience.

There was that 20% who said documentation is a challenge. There is preparation, but each practice has different systems. So in onboarding, you have to onboard in the systems, and possibly think about best practices so they can focus on the patient while doing the necessary administrative paperwork.

And then AI. They are asking for training on AI, which can mean a variety of things. From working in education, I have a lot of thoughts on what can be done to prepare before PAs come into practice. There is a level of preparedness that needs to happen around understanding AI and how to use it.

From a practice perspective, one, at a higher administrator level, integrate tools that make clinicians more efficient and effective, but are already proven to be trusted, approved, and acceptable for use. And two, provide clear guidance in onboarding about what is acceptable to use and what is not, and how to use it. That kind of onboarding training, specifically in the ecosystem of, “These are the tools that we have.”

Physicians Practice: If you were designing the ideal onboarding plan for a busy clinic, what are the must-haves?

KV: There are so many things they are already doing. The must-have add-ins are a plan related to guidelines and policy. What are the technologies we currently have integrated into our systems? How are you able to use those AI technologies, addressing head-on what “shadow AI” is and unacceptable uses?

There are all kinds of open sources proliferating, and you might think, because you use it day to day in your personal life, as a new clinician, “Oh, let me run my notes through this.” That is not acceptable.

So it is important upskilling. Incorporate clear understanding in policies and onboarding. I do not think everyone even knows the term “shadow AI.” Understand there is acceptable AI, and things you do day to day might not be OK to leverage in the practice. That is true in any organization.

Physicians Practice: We’ve already touched on it a little bit, but the report really looks at workflow friction among PAs. What do you see as the root cause of that?

KV: I was with a PA today at my medical appointment, and they have to write things down for the organization. They also have to type things up. It has to go into an EHR. They want to focus on the patient.

I was also working with a PA student today. Every place she has rotated has a different system. So imagine adjusting to different systems all the time. The systems are necessary, and there is a lot that needs to be written up and stored, but you are there to focus on the patient and give the best care. That is the friction. It is necessary workflow, but it takes you away from the passion and the mission.

How can we make it more efficient while keeping that documentation? That is the opportunity for AI, too, to integrate into the workflow in ways that are protected and secure. The friction is that this is not the reason you do the job. It is just a necessary part of the job.

Physicians Practice: Part of that is the balance of productivity and quality and documentation. How should practice managers balance those expectations when bringing in newer clinicians?

KV: I am still thinking in the vein of AI, but in general, when you are brand new, you are learning for the first time. You are learning full-time responsibilities and juggling all that. That is why documentation can be a friction point. The reason you get into the field is that the patient has a good experience, the diagnosis and support are correct, and they are on the treatment plan they need.

So put thought into training related to tools and systems that make clinicians more efficient, so they feel like they can focus on the core part of the responsibility.

Physicians Practice: So AI is all over the report. It seems to me, correct me if I’m wrong, because often I am, that practice leaders should think of AI more as augmentation of what clinicians can do, rather than a replacement or an add-on. More like, how can this help our employees? Does that sound right?

KV: There are so many opportunities and uses in health care for AI. And I will take a moment to mention: any radiologist will talk about how AI is already being used as a second read on our scans. An expert human is still in the loop, but there is also AI detecting maybe something we did not see. There are so many use cases.

I mentioned documentation. Clinicians, PAs and others, already reference evidence-based sources and look things up when they are trying to diagnose and treat. In my everyday work, I can leverage AI to scan multiple sources more quickly and bring back information, but with cited references.

The other thing is, instead of looking at AI as a separate thing or toolset, think about how these features will be integrated into trusted, evidence-based, secure workflow solutions we already implement. So yes, rather than, “AI is the solution,” AI is a feature that augments a solution and makes it more powerful in everyday practice so you can be more efficient. That is where we want to see AI go. And practices should be thinking about evaluating current solutions to make sure they have expert AI, trusted AI, built into those solutions.

Physicians Practice: So if a practice manager watches this video or looks at the report, what’s one thing they can do differently next week?

KV: One thing they can do is sit down as a team and work on policies, documenting and planning communication of policies related to acceptable use and safe use. Do not assume, because it is so nascent and evolving, that every clinician coming in has the same understanding. You and I might say, “Of course you never put something in an open AI,” but with things changing so much, do not assume anything. Sit down, document your current policy, and revisit it.

And you might not actually have AI solutions integrated into your current workflow yet. Make a plan to evaluate with your vendors and different solutions. What is going to be incorporated related to expert AI? How can you train your staff and team to leverage it? And explicitly write policy for clinicians about what they can and cannot use today.

Physicians Practice: I think that’s all the questions I’ve got for you. Is there anything else you want to add, anything you think I’m overlooking?

KV: I would just say, I know you are very focused on practice, and practice begins with education. We did this survey to think about what we need to do more upfront in education, in the years you are studying at the university to become a physician associate.

There is a great message in the survey for PA programs to think about how they are modeling use of AI in education, and how they are communicating acceptable use, or not, in the curriculum. So that when a practice manager gets a new clinician, they already have a mindset related to this. It is evolving so rapidly, and that connection is really important.

Then when they get to practice, they can be trained on the specific tools and use cases, but they still have a mindset for how to think about appropriate use, because it is going to be transformative.