Not long ago, a physician assistant with more than ten years of experience said something to me that I have not been able to shake: “I don’t belong. I have no place to go in my career.”

This was not a struggling clinician. This was a capable professional who had given a decade of skill and heart to patients. Somewhere along the way, the system they served stopped seeing them as anything more than capacity.

I have heard versions of that sentence many times since, from nurse practitioners, PAs, midwives, and CRNAs. It led me to a harder question: Is this a workforce problem or a design problem? I believe it’s the latter.

Healthcare has expanded the advanced practice clinician workforce rapidly. We know APCs improve access and that patients depend on them. Yet utilization varies widely, roles are often unclear, and career paths are often flat. In too many settings, the only way “up” is out.

For decades, we have asked how to help clinicians work within our systems. Maybe it is time to ask: What if we developed these professionals, not just to work in the system, but to help us design a better one?

Picture a seasoned nurse practitioner in cardiology or a physician assistant in primary care who understands workflow, handoffs, access barriers, and exactly where the system breaks down under pressure. Now, imagine inviting that person to the table when your health system redesigns care or plans for the future.

I believe leadership is not a title. It is a way of caring for people and the systems that serve them. Some of our best leaders are hiding in plain sight. When we invite them in, we gain their perspective, and they gain something just as important: the knowledge that they belong.

The APC conversation usually turns to scope of practice and regulation. Those issues matter, but they are only the visible layer. The real opportunity lies underneath: clarifying roles, modernizing workflows, and seeing APCs as leaders, not just labor. Get that right, and we won’t be having this same conversation ten years from now.

The vision we are working on develops APCs in two directions at once.

Horizontally, we follow the patient, not the org chart. Patients don’t experience departments. They experience a journey from prevention through acute care, post-acute care, home care, and hospice. APCs are uniquely positioned to bring continuity across those transitions, which is exactly where patients need the most support.

Vertically, we develop APCs from excellent clinicians into healthcare leaders. This is not one narrow ladder but a true career architecture, with pathways into education, quality, research, AI, care-model design, and enterprise leadership.

Imagine giving that PA an answer the next time they ask, “Where can I go from here?”

This is not a physicians-versus-APCs argument. Physicians bring essential diagnostic, procedural, and specialty leadership. APCs bring continuity, coordination, and systems awareness. Nursing remains an essential partner. One question I keep asking leaders is this: What work are your physicians doing today that keeps them from doing the work only they can do?

AI is accelerating this shift. Used well, it can help APCs practice at the top of their capability. But we should not use technology to automate yesterday’s healthcare model. We should use it to help redesign tomorrow’s.

Real change takes more than a new organizational chart. Physicians, nursing leaders, executives, and APCs themselves will have legitimate questions about authority, accountability, and support. That is why the model has to be designed together. The best path forward is to start small and learn fast: one APC leader, one physician partner, one nurse leader, one executive champion, one patient journey, one real bottleneck, and one clear measure. Demonstrate. Learn. Refine. Then scale.

I keep coming back to that PA. What if the next time someone like that looks at their career, they see belonging, and they see a path? That’s how we get to what really matters: better health for the patients who count on us.

What would it take for your organization to fully develop and use APC leadership?

Today I am working with @dancollard and @quintstuder to help make this vision real. Whether you joined our APC breakout at the Rewiring Healthcare: Foundation to Future conference or are new to this conversation, I’d love to hear from you at Info@HealthcarePlusSG.com or Don@DTaylorLeadership.com.

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