This article previously appeared in the May 2015 issue of PA Professional
Increasing Access to Care From a Leadership Position
By Dave Andrews
There was a time when PAs practiced medicine exclusively. But as the profession continues to mature, PAs have increasingly taken on more administrative leadership positions–many becoming group practice executive directors, medical center PA directors, and some even serving as hospital chief operating officers.
Physicians have traditionally filled the roles of medical directors. However, with the right background and determination, many PAs have shown they, too, have what it takes to be successful in those positions.
One prime example is PA Javier Esquivel-Acosta, who for several years served as associate medical director at the Foothill Community Health Center (FCHC) in San Jose, Calif. The center oversees a number of local health clinics throughout the area.
Esquivel-Acosta moved to the United States in 2004 from his native Mexico, where he worked as a physician. He was looking for new opportunities to work in medicine and improve the health of those in need, and quickly took an interest in the PA profession.
After graduating from the Stanford University PA program, passing the PANCE and obtaining his PA license, he worked in various healthcare roles in the Bay Area. His goal was not to obtain a medical directorship, but when the opportunity presented itself at FCHC, he knew he was the right person for the job.
“When I applied for the [associate medical director] job, our CEO and medical director initially questioned whether or not it could be given to a PA,” Esquivel-Acosta says. “By that time, I had already done some research and was able to reference several other PAs in similar roles at hospitals and clinics in the surrounding region. I knew it wasn’t going to be easy, but I knew it was possible.”
According to Bindu Chandran, MD, medical director at FCHC, what made Esquivel-Acosta the clear choice for the job was his familiarity with the center—having already worked there for more than three years—along with his work ethic and dedication to helping improve the health of the medically underserved.
“Javier was one of our most productive providers, and he always had new ideas about how to make things better for the patients and the staff,” Chandran says. “No matter what you asked of him or what the issue was, he would do a thorough evaluation—researching other clinics in the area and considering industry best practices—and then bring his proposed solutions to the table.”
Immediately after accepting the position, he got to work. Esquivel-Acosta created several departments that have redesigned processes and improved quality. He heads up the innovation department, which impacts several areas of the center’s operations including optimizing medical record data, identifying new clinical standards and improving patient outreach.
Additional departments Esquivel-Acosta created include the health education department, where nurses on staff help coordinate care for patients with chronic conditions. A new referral department ensures specialist referrals are processed quickly and accurately. And an on-site call center was established to alleviate the growing number of inbound calls fielded by the front desk.
Esquivel-Acosta said the leadership at FCHC was usually very supportive of what he calls his “unorthodox” ideas. “We’re continually focused on finding new ways and developing new programs to help the staff work more easily and efficiently,” he says. “The result is often improved quality, which eventually leads to improved patient health.”
Though unorthodox may be a light-hearted description of some unique approaches adopted by FCHC, the significant increase in revenue might indicate more ingenuity than lack of orthodoxy. Between 2011 and 2015, annual revenue soared from less than $500,000 to nearly $12 million.
Chandran said the success at FCHC cannot be attributed to just one person or program. Rather, credit is due to the talented support team of clinicians and administrators who all contribute to the overall goals of the center.
What sets Esquivel-Acosta apart from many, according to Chandran, is his willingness to take initiative and inspire others to do the same. Each staff member knows what his or her unique role is and has a better understanding of what is expected.
“Javier is very compassionate with his patients, but he’s also passionate about helping the employees,” says Jessica Pedder, quality assurance director at FCHC, who has worked with Equivel-Acosta for more than three years.
Pedder said Esquivel-Acosta would always challenge his co-workers and others within the organization to work to their full potential, knowing it was not just about keeping the patients happy, but the staff as well.
“So often, I see people gravitate toward PAs because of the unique way that they take the time to share what they know and to find the solution; I see that with Javier,” Pedder says. “He is deeply respected by his patients and peers. People truly listen when he offers his thoughts and opinions, and that comes not just from his expertise, but also his approach to problem solving.”
As associate medical director at FCHC, Esquivel-Acosta had to apply many of the skills he’s learned throughout his entire career. In Mexico, he practiced family medicine within rural communities, supervising medical staff and educating patients with chronic diseases about how to better manage their condition. After moving to the U.S., he worked as a case manager for the California Department of Developmental Disabilities Services, evaluating client needs, coordinating care access and advocating on behalf of his clients who needed government assistance.
These skills were essential to Esquivel-Acosta’s advancement at FCHC, which as a federally qualified health center, provides services to anyone in need of healthcare, regardless of his or her ability to pay. Its focus is on providing primary care and preventive care, predominantly serving underserved, underinsured and uninsured populations.
“My passion has always been helping low-income families,” says Esquivel-Acosta. “There were other job offers with higher salaries, but this was where I felt like I could have the most impact.”
Many within the center’s patient population are without transportation. For that reason, Esquivel-Acosta and his FCHC colleagues dedicated much of their focus to increasing access to care.
For example, FCHC continues to expand its school-based clinics at public high schools throughout the San Jose area. From 2012 to 2015, the number of FCHC-managed clinics increased from three to 13. It also created extended hours of operation to 10 p.m. seven days a week for most of its clinic locations.
Cultural competency is another significant factor for providers in this region. For that reason, the number of providers at FCHC who speak Spanish and/or Vietnamese continues to grow. Most are also aware of and considerate to the unique cultures and customs within their diverse patient population, which can often help put the patient at ease.
To his fellow PAs who might be considering an administrative or leadership role, Esquivel-Acosta advises that they should focus first on doing whatever is necessary to become—or continue to be—a successful PA.
“Once you know what it takes to achieve success as a PA in your unique environment, try to identify ways you can help your fellow staff members,” Esquivel-Acosta says. “From there, take it a step further and look for opportunities—big or small—to impact the specific needs of your community.”
Dave Andrews is a freelance writer and public relations professional based in Northern Virginia. Contact him at [email protected].