Supervision vs. Collaboration in Physician-PA Teams

I have thought a lot about what it means to “supervise” a physician assistant (PA) over my more than three decades in the practice of medicine as a PA. That word has never truly captured the core elements of the relationship that I have had with the physicians with whom I’ve had the privilege and honor of practicing medicine.

Our relationship is better described by the word “collaboration.” I practice medicine and make medical decisions with a significant amount of autonomy, within the context of a healthy and mutually beneficial relationship among all members of our medical team.

Within the context of my current team practice with my physician partner/surgeon, I am fully trusted to independently make a number of decisions regarding admissions, discharges, comprehensive management of treatment plans, managing the surgery schedule, etc. After five years of inpatient/outpatient practice together, we are of one mind of how to best take care of our patients.
Yet archaic practice laws and regulations in California, as in many other states, impose administrative burdens and other barriers to full and effective team-based practice and do not protect the consumer by any measure that I have seen.

Physician-PA teams practice best when there is mutual trust and understanding between all members of the team, when strengths are known and embraced, and when communication improves patient outcomes and efficiency.

How physician-PA teams function in the real world should take into account experience of the PA and should be determined at the practice level, not the legislative level. In my experience, this is how it works right now at the practice level despite the administrative burden imposed by the regulatory and legislative systems. The laws should reflect the practice realities.

New technology like EHRs and telemedicine has significantly lessened the administrative burden of physician-PA teams imposed by the regulatory system, but such oversight requirements still create problems and distractions from the efficient and effective delivery of patient care by these teams.
The American Academy of Physician Assistants (AAPA) has broken down the key elements of modern PA practice into six items. They include:

“Licensure” as the regulatory term;
Full prescriptive authority;
Scope of practice determined at the practice level;
Physician on-site requirements determined at the practice level;
Chart co-signature requirements determined at the practice; and
No restriction on the number of PAs with whom a physician may practice

You can see just how your state stacks up when it comes to embracing the six key elements here.

The Affordable Care Act (ACA) has provided much of the impetus for an unprecedented number of improvements to PA practice laws. So far in 2014, 44 states and the District of Columbia have improved PA practice acts. That’s on top of the improvements made in 43 state and the District in 2013. The momentum is clearly building to enable PAs to practice to the fullest extent of their experience and education.

While each of the six elements identified by the AAPA is important, numbers two through five are the most important to me in the real world. In fact these key elements really reflect how physician-PA teams actually work in the real world and have been tested over decades.

Physicians who practice with PAs on a regular basis know what I’m talking about.  As the team evolves and develops extensive patient care experience together, the physician acquires substantial trust in the team and PA, and extends significant autonomy to the PA in getting the job done of caring for their mutual patients. The oversight required of a PA with many years of experience in inpatient and outpatient care is much lower than a new graduate.

The bottom line is that we need to keep at the team level the decisions regarding how the team functions in day-to-day practice. We need to develop regulatory and legislative strategies that get out of the way of effective team practice.
 
Having good practice environments in every state for physician-PA teams is good for our patients and good for physicians.

This blog was provided in partnership with the American Academy of Physician Assistants.