As a long time physician assistant, I have had the privilege of watching firsthand the evolution of the PA profession. From four Navy corpsmen, trained in 1967 to help address the looming shortage of physicians in America, to the present day count of around 123,000 PAs, the profession now works in every specialty, subspecialty, and health care setting you can imagine.
I would have never predicted the present day growth and diversity of the PA profession when I started in 1981. Part of that growth, and what represents a big step forward, took place in May 2017, when the PA profession adopted policy on a broad vision of the profession’s future, called “Optimal Team Practice” (OTP).
Optimal Team Practice calls for laws and regulations that:
• Emphasize PA commitment to team practice;
• Authorize PAs to practice without an agreement with a specific physician—enabling practice level decisions about collaboration;
• Create separate majority-PA boards to regulate PAs, or give that authority to healing arts or medical boards that have as members both PAs and physicians who practice with PAs; and
• Authorize PAs to be directly reimbursed by all public and private insurers.
As the American Academy of PAs (AAPA) liaison to the American Medical Association, I have witnessed confusion about this policy and its evolution. I and members of the leadership and staff of the AAPA continue to work hard to address common misperceptions about what this policy means for the PA role.
PAs are committed to working with our physician partners to address concerns and renew our commitment to the team practice of medicine. I’ve included a list below of six things PAs want physicians to know about the new policy.
1. PAs do not want independent practice.
PAs value a sustained partnership with physicians, have great respect for the depth of physician training, and rely on the PA-physician team in clinical practice. Indeed, the profession is deeply committed to team practice. PAs simply want to remove the requirement for a PA to have an agreement with a specific physician in order to practice. This also removes physician liability for the care that PAs provide and reduces physician risk of disciplinary action for administrative reasons unrelated to patient care outcomes. This makes perfect sense if you look at the change in the practice of medicine over the past 50 years. Working arrangements of physicians and PAs have evolved, and the tradition of a PA being employed by a physician is no longer the norm.
2. PAs do not want to change the PA role.
The PA role is well established. PAs will continue to be legally and ethically obligated to consult with and refer patients to physicians based on the patient’s condition, the standard of care, and the PA’s education and experience. This is how I practice day-to-day right now with my surgeon partner. Our relationship and trust have evolved to the point where he knows that I will care for patients in the same manner as he would and knows that I will consult with any questions. This collaboration should be determined at the practice/team level.
3. PAs want to strengthen health care teams.
Optimal Team Practice will make health care teams stronger by reducing administrative burdens and enabling practice-level decision making. State laws should not dictate to physicians how many PAs they may collaborate with or which charts must be co-signed. Those decisions should be made at the practice level where the care is being provided.
4. PAs want to have meaningful input into the regulation of their profession.
PAs want what physicians and nurses already have: regulatory boards that have current knowledge of their profession. Whether that requires a separate PA board—or just the addition of PAs and physicians who work with PAs as members of a medical or healing arts board—this should be determined on a state-by-state basis. In California, we already have a PA board, as do a handful of other states. But in most states, PAs are regulated by the medical boards, the minority of which have PAs as members. Why should PAs be the only health care profession in the nation to not govern and discipline members of their own profession?
5. PAs want a level playing field with nurse practitioners.
In a 2017 survey, 45 percent of PAs said they have personally experienced NPs being hired over PAs due to the administrative burdens imposed on employers and physicians requiring that PAs have an agreement with a specific physician.
6. PAs want to remain viable in the changing health care marketplace.
Unlike physicians and advance practice nurses, PAs are not eligible for direct reimbursement under Medicare. This means that PAs cannot work with certain staffing companies or in some corporate medical structures because PAs cannot reassign their insurance payment to their employers. This puts PAs at a disadvantage in the health care marketplace.
In many ways, when you look at the way in which long time, experienced PAs like me practice, our team already is committed to the concepts of OTP. When you actually look at what OTP means for PAs, physicians, and the health care system, it makes sense for physicians and others to support OTP. Patient care, safety, and quality of life for all members of the heath care team can be expected to improve with this new policy.
Stephen Hanson, MPA, PA-C, practices in general surgery as well as plastic and reconstructive surgery in Bakersfield, Calif. He is a past president and speaker of the American Academy of Physician Assistants.
