Physician Assistants Can Reduce Risks Through Teamwork: 5 Strategies

Whether physician assistants deliver primary care, assist with cardiothoracic surgery, perform procedures in the emergency department, or practice in other settings, we are part of a team—and our teams are in high demand. As care shortages intensify around the U.S., the pressure is on to implement best practices to safely manage patients’ care.

While delivering high-quality care, PAs can increase patient safety and mitigate liability risks by committing to teamwork. We can use structured communication tools and escalate when necessary. We can also seek and offer mentorship to foster career-long development—we work in one of the fastest-growing professions in the U.S., so we create positive ripple effects through our own professional development and supporting that of our colleagues.

PAs can mitigate our professional liability risks through committing to five strategies for safety and teamwork:

1. Elevate Awareness of Scope of Practice and Liability Risks

The physician assistant profession has been around for more than 50 years. We began as dependent practitioners working under physician supervision. Originally, our role developed through a confluence of former military medics seeking advanced skills and physicians seeking highly trained healthcare professionals to assist with procedures, as well as to shoulder other care responsibilities.

Fast forward to 2024. Healthcare has evolved, and our role has expanded, along with our geographic reach: States with the greatest density of PAs per patient population include Alaska, New York, and North Carolina. Our scope of practice varies by location, but overall, PAs today face higher liability risks than before:

1. When a person is making more autonomous decisions around patients’ care, that increases their potential liability.
2. PAs are now treating more complex patients, which inherently increases risk.

During my 20-plus years as a PA, our access to technology and pharmacologics has increased. So has the complexity of the care that we deliver, and so has the medical complexity of our patients. In cardiology, when I first started working in a team-based role, we did not take patients that were over 80 years old to the cardiac catheterization laboratory. Now, PAs are contributing to the management of 95-year-old patients who are receiving valve replacements or valve management and stenting. Contemporary care models produce a very different environment. The technologies have evolved, our guidelines have evolved, and the complexity of patients to whom we are delivering care has evolved.

That’s why our ability to escalate to another level of care is key. Each of us needs to understand our own limitations as a practitioner relative to skills and experience. These internal limitations will shift over time, and external factors may shift over time, as well: If the scope of practice changes in your state, then your liability exposure will change, so it’s in your best interests to keep an eye on developments in your area, discuss these with your team, and adapt role definitions as needed.

As we do right for our patients, we need to understand our risks as practitioners and make sure we’re mitigating those risks through good education, through good communication, and through malpractice coverage that is proportionate to our risks.

2. Make Practice Culture a Priority in Job Seeking

Miscommunication is often an amplifying force in malpractice allegations. Fortunately, study after study proves that good communication exerts a protective effect against adverse events and malpractice lawsuits. With this in mind, as PAs, one of the ways we can protect ourselves is working in a good team culture. In job seeking, look for two main hallmarks of healthy culture:

1. Team members show respect for each other’s professional skills, expertise, and experience.
2. Practice management thoughtfully structures teams to allow clinicians with different roles and responsibilities to practice at the top of their respective licenses.

Consider how many people might be on a PA’s team: physicians, other PAs, nurse practitioners, dieticians, social workers, pharmacists, nurses, nurse midwives, or nurse anesthetists. All of us, as healthcare professionals, have skillsets that we have acquired through our education and clinical experience.

Top-of-license care means everybody on the team has roles and responsibilities that are aligned with their license, skill set, and education. In a team-based model, typically roughly 80 percent of the work that someone does should be within their license level, meaning they should be the only one on the team who can deliver that care. When people spend more of their time doing non-license-specific work, that suggests that the team’s responsibilities should be allocated differently.

3. Collaborate With Structured Communication Tools

Researchers have found that malpractice claims involving communication errors between team members close with greater expenditures than those involving communication gaps between the care team and the patient/family. However, they also found that around 75 percent of those in-team communication gaps between team members could have been closed with a structured communication tool.

PAs can improve patient safety by rigorously adhering to whatever structured communication tools their practice or institution has already adopted. If no tool has been adopted, PAs can advocate for the implementation of SBAR.

The Agency for Healthcare Research and Quality outlines SBAR this way:

Situation: What is going on with the patient?

Background: What is the clinical background or context?

Assessment: What do I think the problem is?

Recommendation or Request: What would I do to correct it?

SBAR feels familiar to many of us when we first encounter it, perhaps because SBAR follows a similar train of thought to the SOAP note (subjective, objective, assessment, plan). For practitioners across a variety of disciplines, this similarity to the SOAP note makes SBAR the structured communication tool of choice, because it’s easy to follow through on our intention to use it. SBAR is also helpful in that it engages the practitioner to identify a recommended plan.

4. Advocate for Patients With Structured Escalation Tools

Skilled as we are, PAs do not deliver care in a vacuum. Good patient care is interdisciplinary team-based care. So when a patient’s condition changes, part of risk mitigation for PAs can be knowing when to say, “This is beyond my skill.”

There may also be times when we feel uncomfortable with a patient’s condition and we need to escalate our concerns. We have access to a specific structured communication tool for this purpose. We can use the CUS tool to quickly and professionally advocate for our patients while remaining respectful to our teammates. The script is:

C: I am Concerned.

U: I am Uncomfortable.

S: This is a Safety issue.

Speaking of uncomfortable: For many of us, confrontation is not comfortable, but to reduce risks for our patients and ourselves, we need to master it. Part of good teamwork is knowing we can work through conflicts. If we bring the willingness to step up, the CUS tool will take us where we need to go.

If we do not get a satisfactory response the first time, we should persist in escalating up the chain until we are satisfied that our patient is safe and our risks as practitioners have been mitigated.

I encourage everyone, especially newer practitioners, to practice using this tool.

5. Support Mentorship and Professional Development

PAs are a young profession overall, with roughly two-thirds of PAs under 40 years old. As you’d expect, given those age figures, more than half of PAs have fewer than 10 years of clinical experience.

We are young but mighty: The PA profession is one of the fastest-growing professions in the country.

Our strength in numbers and our youth as a group together show the value of mentorship and of investing in our professional growth:

1. Mentorship: Experienced practitioners can support new clinicians both formally and informally. We can teach and mentor in structured programs. We can also welcome new team members with offers to coach them or act as their phone-a-friend contact as they build experience and confidence in their skills and care.
2. Modeling: Experienced practitioners can also continue to hold themselves to a high standard and model best practices for teamwork.
3. Seeking guidance: Newer healthcare professionals can actively seek out exemplary models and mentors as they solidify their clinical skills.

Protecting Our Emerging Profession

Today’s PAs are highly educated and skilled in delivering healthcare to patients with increasingly complex needs. The healthcare setting itself is growing more complex: Healthcare delivery demands ever more collaboration, and patient access challenges are intensifying.

Also intensifying are malpractice risks for healthcare practitioners. Most practitioners will be the target of a lawsuit at least once in their career, with or without the occurrence of a medical error. Unfortunately, the professional liability coverage offered by many employers is not keeping pace with PAs’ risks—which becomes conspicuous with our scope of practice increasing in many states.

Licensing board complaints are a topic of special concern. Employer-provided coverage protects the organization, but it may leave gaps relative to practitioners’ board complaint risks—risks that persist with or without actual fault.

Through prioritizing best practices for teamwork, keeping pace with clinical developments, and keeping our professional liability coverage proportionate to our risks, PAs can do right by our patients while mitigating our own professional hazards. We can protect our ability to practice in our chosen profession for years to come.

Consider requesting a quote for professional liability insurance tailored for PAs.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

The opinions expressed here do not necessarily reflect the views of The Doctors Company. We provide a platform for diverse perspectives and healthcare information, and the opinions expressed are solely those of the author.