The physician assistant workflow crunch: shadow AI risks and documentation drag

For practice leaders, the message from the PA survey is that onboarding has to do two jobs at once: set clear guardrails for “shadow AI” before clinicians default to consumer tools, and reduce the documentation churn that keeps pulling attention away from patients.

In discussing survey findings, Kelly Villella of Wolters Kluwer said workflow friction builds when PAs are forced to juggle handwritten notes, EHR entry, and ever-changing systems across sites; making secure, integrated AI and explicit policies a practical way to streamline paperwork without compromising compliance.

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

Kelly Villella: There are so many things they’re 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’s not acceptable.

So it’s important upskilling: incorporate clear understanding in policies and onboarding. I don’t think everyone even knows the term “shadow AI.” Understand there’s acceptable AI, and things you do day to day might not be OK to leverage in the practice. That’s 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’s rotated has a different system. So imagine adjusting to different systems all the time. The systems are necessary, and there’s a lot that needs to be written up and stored, but you’re there to focus on the patient and give the best care. That’s the friction. It’s 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’s the opportunity for AI, too; to integrate into the workflow in ways that are protected and secure. The friction is: this isn’t the reason you do the job. It’s just a necessary part of the job.