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PAs Want Full Collaboration Not Independence


While nurse practitioners seek practice autonomy, physician assistants work to ensure greater state-by-state consistency in scope of practice laws.

As a certified physician assistant (PA-C) that practices medicine in two specialties and in two bordering states, I see the need for state laws to change so that PAs everywhere can practice to the full extent of their license.

A certified PA with over 30 years of experience, I practice family medicine in New York State and emergency medicine in Pennsylvania, treating patients with all levels of acuity in both states. Yet the laws that govern my practice as a PA change as I cross the border. In today's highly mobile society, the public would benefit from uniform state laws that provide oversight of the PA profession.

PAs are educated in the medical model and taught to be part of the healthcare team. We are certified through a rigorous national exam and then maintain certification throughout our careers by meeting substantive CME requirements and passing a national recertification exam every 10 years. We respect our collaborative relationships with physicians. We do not want independent practice, but we do want appropriate latitude to apply our skills and knowledge wherever we practice. When we move from state to state, we want to practice medicine at a level that makes full use of our education and abilities.

Because state laws have been enacted one-by-one over many years and because PAs now work in every specialty area and clinical setting, the laws haven't kept up with the growth and changing needs of the U.S. population.

The American Academy of Physician Assistants (AAPA) defines six key elements for modern PA practice.

1. "Licensure" as the regulatory term. Because state laws sometimes refer to licensed health professionals, it is essential that states also "license" versus "register" PAs (49 states and the District of Columbia support).

2. Scope of practice determined at the practice site. The physician and PA are the best judge of a PA's abilities and what is best for the team and patients. State laws that try to list or limit what a PA can do create bureaucracy, inequality and delays in care (34 states support).

3. Adaptable supervision requirements. Some states require a physician to be on site with the PA at certain times. While this makes sense in some settings, it may not make sense in others as long as the physician is available by some form of communication (26 states and the District of Columbia support).

4. Full prescriptive authority. PAs complete extensive coursework in pharmacology and we need to be able to prescribe Schedule II-V controlled medications. The physician should have the ability to delegate full prescriptive authority to the PA without state restrictions (39 states and the District of Columbia support).

5. Chart co-signature requirements determined at the practice level. When a state has strict rules about the percentage of charts a physician must co-sign, it creates an administrative burden that takes time away from patient care (24 states and the District of Columbia support).

6. Number of PAs a physician may supervise determined at the practice level (11 states support).

Pennsylvania laws support two of the six key elements (licensure and full prescriptive authority). New York State laws agree with five of the AAPA's elements, but still place restrictions on the ratio of PAs to physicians.

PAs are not seeking full autonomy like our nurse practitioner colleagues.  We do want state-to-state consistency. The benefits include:

•Increased access to care. Laws regulating prescriptive authority or scope of practice trickle down to the patient and limit their ability to receive timely care.

• Improved patient communication. PA programs are heavy on science but also include the art of communication. I always introduce myself as "Hi, I'm Cathy, the PA, and I'm here to take care of you today." This opens the door for them to tell me what is on their mind.

• Patient-centered, quality care. Open communication allows us to treat today's symptom while helping patients maintain their own health and avoid preventable problems.

• More affordable healthcare. PAs are cost-effective providers who can treat most patients, freeing up physicians to handle more complex cases.

PAs embrace team care and the collaborative nature of our relationship with physicians. We need all states to comply with the six elements of modern PA practice so that we can more fully support physicians and all our team members.

Cathy Gillespieis certified by the National Commission on Certification of Physician Assistants. As a certified PA, she has experience in pediatrics, women's health, primary care, and emergency medicine. She is both past president and president-elect of the Pennsylvania Society of Physician Assistants. Gillespie can be contacted at catherinegillespiepac@gmail.com.

This blog was provided in partnership with the National Commission on Certification of Physician Assistants.

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