The physician shortage coupled with higher patient demand for healthcare services is opening several doors for nurse practitioners and physician assistants. But the debate, regarding which doors should be opened, continues.
New "turf battles" over the appropriate scope of practice of advanced practitioners seem to ignite on an almost monthly basis, and it can be difficult to keep track of what changes are taking place, where, and when. In the first seven months of 2014 alone, 44 states and the District of Columbia "modernized" their PA practice laws and regulations, according to the American Academy of Physician Assistants (AAPA). On the NP front, Minnesota recently became the 19th state (in addition to Washington, D.C.) to allow NPs to practice without physician supervision.
Physician organizations are quite vocal regarding scope of practice issues, particularly when it comes to the independent practice of NPs. Both the AMA and the American Academy of Family Physicians (AAFP) have repeatedly stressed that healthcare teams should be "physician-led."
Regardless of where you stand on this issue — and many others related to scope — it's likely you will begin working more closely with advanced practitioners, as more enter the healthcare system each year. Since 1999, the number of NPs practicing in the United States has jumped from 60,000 to more than 192,000, according to the American Association of Nurse Practitioners (AANP). By 2025, that number is expected to reach 244,000. On the PA front, the number of PAs practicing has nearly doubled every decade since the first PAs graduated in 1967, according to the AAPA. Today, more than 100,000 certified PAs practice in the United States, and more than 7,000 matriculate into the workforce each year.
To ensure that you are utilizing this growing workforce of advanced practitioners in smart ways, we asked the AMA, the AAFP, the AAPA, and the AANP to weigh in. Here's a closer look at some of the most recent scope-of-practice changes; and how these four organizations say physicians and advanced practitioners can learn to work better — together — to improve patient care.
Physician assistants
Many of the recent changes to PA legislation have been due to the need to update "outdated" state laws, says AAPA President John G. McGinnity. "For us, being a new profession, we weren't around when a lot of these laws were created, so we weren't specifically named," he says.
One recent example of this type of change in legislation occurred in March, when Oregon Gov. John Kitzhaber signed Oregon Senate Bill 1548 into law. The bill clarified and updated 75 statutes that reference "physician" to also include references to "physician assistant."
Also propelling PA legislation changes, McGinnity says, is a growing awareness of the benefits PAs bring to patient care, as team-based care concepts like Patient-Centered Medical Homes gain momentum. "You're seeing people rethink team medicine, and PAs, we were team [oriented] before team was cool," says McGinnity. "We've been doing team-based medicine since the 1960s, so we're very comfortable in that environment."
In January, the Indiana Office of the Secretary of Family and Social Services adopted a regulation that allows adult mental health habilitation services to be covered by Medicaid. PAs are included within the new rule as "authorized healthcare professionals" and "qualified behavioral health professionals," which allows them to administer drugs and order medical services for adult mental health patients. In July, Missouri Gov. Jay Nixon signed a bill authorizing PA enrollment in the state's Medicaid program. Enrollment authorizes PA services to be billed under the PA's National Provider Identifier or a unique modifier.
