A recent letter from the American Academy of Physician Assistants (AAPA) caught my attention as a surgical PA. AAPA President James E. Delaney has expressed concern regarding a resolution that will be considered by the American Medical Association House of Delegates (AMA HOD) this weekend.
As those of you who work with PAs know, PAs and physicians work in close alignment in the clinical and surgical setting, and that is generally the case in the policy arena as well.
By way of background, in 2010 the AMA HOD considered a resolution on pain management and invasive procedures. It was referred to committee for revision, and the AMA HOD has been awaiting the revised report and resolution. Report 16 of the AMA Board of Trustees was recently released (recommendations begin on page 19 of that report). To make a long and complex story short, the recommendations in this report are very restrictive, do not display an understanding of the way physicians and PAs work together, and have the potential to be very limiting to the physician-led team practice of medicine.
The proposed resolution expands the definition of surgery to include "repair or removal of an organ or tissue," and adds, "Surgery is performed for the purpose of structurally altering the human body." Although parts of the resolution are somewhat unclear, the overall implication is that surgery is to be performed only by physicians. If adopted as presented, the resolution will call certain aspects of medical practice, which are currently performed by PAs, and well within the standard of care in many specialties across the country, into question.
Is this really good for the team practice of medicine in the face of full implementation of the Affordable Care Act in a few short months? Do we suddenly have an adequate number of physicians trained to serve every surgical and trauma role within the healthcare system in the United States?
Additionally, the resolution states, "invasive procedures employing radiologic imaging are within the practice of medicine and should be performed only by physicians with appropriate training and credentialing."
Recently added language in the resolution holds that "technical aspects of certain invasive procedures may be performed by appropriately trained, licensed or certified, credentialed non-physicians under direct and/or personal supervision of a physician." Direct or personal supervision requires the physician to be in the facility or in the room where the procedure is being performed.
This conclusion, by its vagueness, is very troubling in that it would seem to include many "invasive" procedures that have been routinely and competently performed by PAs for decades in a variety of settings in the team practice of medicine, but not necessarily with "direct or personal supervision." My physician partner covers two hospitals, and I’m based at one. Waiting for his "direct and personal" supervision (I read this to mean in the house), would unnecessarily delay needed care and result in an increase in morbidity and mortality of our burn and reconstructive patients.
As always, the PAs’ approach to this issue will be patient-focused and team based. As I think about PAs in the healthcare system, and think about how the "team" of professionals function as a cohesive, highly trained and experienced unit in our operating room each and every day and during a wide variety of complex and technical procedures, I’m surprised at the AMA’s desire to place arbitrary and capricious limits on teams currently and successfully functioning at a high level in our healthcare system.
The medical boards in states across this nation grant PAs the privilege of the practice of medicine, and define the appropriate potential scope of practice. My physician partner is board certified in plastic and reconstructive surgery, and I believe that he is the best judge of the skills, abilities, and competencies of the each of the members of his surgical and clinical team.
Policies such as the one being considered by the AMA HOD seem to be a solution in search of a problem. These sorts of decisions should be left to the physician leaders of healthcare and surgical teams at the local level, and consistent with existing state law and regulation.
Accessible, affordable, and safe care for all Americans in the modern era depends on this flexibility. It is my hope that testimony at the AMA HOD will reflect these very real and practical considerations, and become a part of a thoughtful deliberative process.
This blog was provided in partnership with the American Academy of Physician Assistants.