PA Leadership Series: Afton Heitzenrater, PA-C

I’m excited to continue posting for our PA Leadership Blog series. Afton is an amazing PA leader as well as a PA entrepreneur and PA innovator. She was kind enough to answer questions about her roles as a leader for her hospital PLUS she gives insight to the awesome medical device she, her husband and a team developed to help patients and providers. Her contributioon and innovation could seriously change the opioid crisis our nation has been facing!

Tell us a little about yourself? Name, how long you’ve been a PA, where you went to school and anything else you’d like to add.

I’ve been a PA for 8 years now. I went to Rochester Institute of Technology right out of high school and received my Bachelors of Science. I started my career in orthopedic and spine surgery while per-dieming at an urgent care center. While working I obtained my Masters of Science from SUNY Stony Brook. My supervising physician retired and I elected at that time to switch to general/colorectal surgery. When we decided to start a family, we wanted to move closer to my hometown, so we moved to Rochester, NY and I’ve been working at Rochester General Hospital (RGH) in the Adult Emergency Department since that time. I took a temporary locum tenens position in family medicine, but really found that a purely office based position was not for me.

What is your role as a leader? (entrepreneurial, administrative, academic, political, etc.)

I have two very different leadership roles. For RGH, I work both clinically and administratively as the Quality Improvement Clinician. This role entitles all aspects of patient and employee safety and quality. Additionally, I am serving as Clinical Advisor and Brand Ambassador for a venture targeting opioid use disorders via “PILL” (Prescribed Interval Limit Lock).  This role came about as my husband had the original idea to control the time in which patients have access to their prescribed opioids to only their prescribed interval.  With the direction of ROBRADY design, a product development group, this idea has developed into PILL.

What does your typical day look like?

Typical day? Hmm, what’s that. I’m not sure in Emergency Medicine there is a typical day. My days and schedules depend on whether I am working a 10-hour clinical shift or in the office working on quality and safety. I also work a rotating days/evenings/nights position, so my day can start at 7am or 10pm. When I’m in the office, my days are filled with meetings, lab followups for DOH reportable results and patients without assigned PCPs, complaint resolution, quality care reviews, devising patient care advisory plans for difficult to manage ED patients, reviewing our internal reported safety events, working on new signage/policies/protocols for the adult ED, and helping ensure workplace safety concerns are addressed. When I get home, I can be on a conference call or working on reviewing/revising documents for PILL. Most recently, I was FDA Innovation Challenge submission. On top of that, I have a bright and active 2 and a half year old that keeps me on my toes. 

If you are clinical, how is your practice set up? What is the structure and what is your relationship with your supervising physician like?

In the ED, we have an assigned supervising physician, but rarely are actually working directly with that physician. We work on a semi-geographic basis in that we have two “sides” of the ED, but any provider is able to see any patient. The only exception is patient’s that are an ESI 1 (need to have a physician involved at the start of workup and treatment) and stroke patients. We have a multitude of ED physicians and they are all fantastic to work with. The nice thing about our department is that we are able to play off of one another’s strengths with particular disease conditions or patient types (ie trauma, , respiratory, procedural needs). Our docs are great to run questions by, sometimes they actually see the patient and sometimes they just attest to the chart that we discussed the case and they agree with our workup, treatment plan, and disposition. All ESI 2’s have to be run by a physician prior to disposition, as well as anyone being admitted.

Do you divide your time into clinical and administrative tasks?

I am split 50\50 administrative and clinical in my primary role, but also do the PILL entrepreneurial tasks on the side.

Did you pursue a leadership role or was it offered to you?

Both! While I’ve always wanted a leadership role, my daughter was only 7 months old when the Quality Improvement clinician role opened up. I inquired about the role with our Medical Director and was asked to interview. They were actually dividing the role from a 70\30 admin\clin split to a 50\50 and a 20\80 split. I felt at the time that I wanted to aim high and went for the 50/50 or “lead” QI clinician role.

How did you prepare for your role? Did you take any leadership courses?

No leadership courses. I sought out a lot of leadership opportunities in high school and then through my prior positions have also dabbled in interim management roles, scheduling, and various committees.

Do you have room or opportunities to grow in your current leadership position?

With regards to the ED, the only other APP held position is Lead APP. The Lead APP and the QI clinician are pretty lateral with very different responsibilities. I dont particularly have an interest in the Lead APP role as that would mean my fantastic lead APP had left us! Rochester Regional Health (a system of 4 hopsitals and outpatient facilities) has an overall APP committee that is lead by an System APP Director, so there is definitely room for movement within leadership roles for PAs.

Are you satisfied with your position? If you could do it all over again, would you?

Currently, I’m satisfied with my position. It keeps me busy and I truly believe that the administrative role in quality make me a better PA and also able to better understand patients. I absolutely love being a PA and would do it all over again in a heartbeat.

Do you think PAs are adequately educated about how to be a leader? If not, do you have any suggestions on what should be taught?

With my education, there wasn’t a lot of teaching on leadership roles, let alone the business side of medicine. I definitely think there needs to be more education on healthcare industry, leadership, management, and patient satisfaction/quality.

Do you have any suggestions for newly graduated PAs interested in becoming leaders in their community?

Get involved early! Volunteer for committees, be kind to everyone, be present, ask questions, and get to know your colleagues (everyone from your environmental service team to the physicians you work with). It’s also important to keep up on reading about the PA profession and continue your education.

Anything else you’d like to add?

The opioid crisis is near and dear to my heart.  About 6 years ago, I lost a cousin to an overdose.  He was only 30 years old.  One weekend on call, I received 8 or 9 phone calls for patients that had used up their opioid prescription early and were requesting a refill.  I am so blessed to have a husband that talks through things and thinks very differently than I do and he morphed our conversation into the idea to limit a patient’s prescribed opioid access to only their prescription frequency via a pill bottle.  The idea came to him while we were discussing Patient Controlled Analgesic pumps (PCAs) as a means to control medication access to postoperative/hospitalized patients.  Today, his original idea has come so very far with the help of the ROBRADY team that truly brought the idea into the 21^st century.  What started as a mechanical idea to modify a traditional prescription bottle has evolved into a “smart” blister pack system that limits a patient to the prescribed interval and dose of their medication.  The device will inherently capture a patient’s use history and link to PDMPs (Prescription Drug Monitoring Programs) for states/pharmacists/prescribers.  The design also supports collecting data for health care providers,  supporting an enhanced understanding of respective patient use as well as anonymized metadata for research.  This could lead to drastic change in prescribing practices for common ailments like fractures and post-operative prescribing quantities. We believe the biggest impact on the opioid crisis can be made at the beginning of the addiction continuum to #stopthestart of misuse and abuse (even unintentional). PILL also addresses diversion through our designed protocol of returning the device to the pharmacy upon completion of the prescription.  While some people will say, “I’d just smash it with a hammer”, our tamper evident packaging will make that self-evident and the patient becomes flagged for immediate attention, or intervention, from their physician. If there’s abusive behavior forming, we want to identify it early and treat it respectively. Those that are already addicted are not our target audience.  If anyone has any interest or comments, please visit the PILL venture page that can be found on the ROBRADY website, www.robrady.com/pill – or contact me!

I want to extend a big thank you to Afton for speaking about her roles, and especially for being a fantastic example of all the various roles a PA can be a part of. Her collaboration with her husband and motivation to make a change could potentially save lives! As I continue to move into the QI world as a PA, I hope she will share more of her brain with us in future posts!

-Courtney