In the early months of 2016, the AAPA Board of Directors began included in their Strategic Plan an intention to explore the concept of Full Practice Authority for PAs. In May 2016, the House of Delegates (HOD) debated a resolution calling for a broader definition of PA scope of practice and support of PAs being granted Full Practice Responsibility. The resolution was referred for further study and as a result the AAPA Board of Directors created The Joint Task Force on the Future of PA Practice Authority (the task force).
In November 2016, the task force released its first report on PA Full Practice Authority and Responsibility (FPAR) which asserted the profession should “consider and commit to this process” that seeks to make the PA profession and individual PAs more accountable.
It is one thing to make the PA profession more accountable through self-regulation, but to suggest the process would make the individual PA more accountable is totally different and un-relatable to one another. Changing the relationship a PA has to a supervising/collaborating physician should have no impact on a PAs RESPONSIBILITY for providing quality service to their patients and being held ACCOUNTABLE for the outcome. To suggest embracing this new process to define the PA profession’s request for an expanded scope of practice and self-regulation will make individual PAs more accountable to their patients is quite frankly disparaging and inaccurate. I have been a practicing PA for more than 40 years and have always understood that I am expected to provide the same quality of service to my patients as though it was being provided by a physician. In doing so, I truly believe I (we) should be held to the same standard of care as a physician and be accountable for my own actions. In the words of the late Paul Robinson, PA-C, Kettering College ’87, and past AAPA Speaker HOD & President-Elect, “Just because I’m reimbursed at 85%, it doesn’t mean I am 15% less accountable or provide a lessor quality of service to my patients than my supervising physician”.
I have also acted as an expert witness for both the defense and the plaintiff in over a dozen medical malpractice suits. In multiple incidence, the supervising/collaborating physician was exonerated from any RESPONSIBILITY for the actions of a PA that had practiced outside of their scope and did not provide service within the acceptable standard of care.
One might understand why the task force would want to title this issue as PA Full Practice Authority and Responsibility as not to use similar terminology as the APRN’s. However, I would caution all PAs and the Academy for using or including the word RESPONSIBILITY in our lexicon when explaining our request for this new process of expanding our PRACTICE AUTHORITY to our physician colleagues and legislators. In my wildest dreams, I never thought I would say this, but I think it may be advisable that we (the Academy) might want to follow the lead of the APRN’s in some respects when addressing this issue. For example, below is an excerpt from the task forces request for feedback in November 2016:
“As PAs, we remain committed to team-based care. We will continue to seek and participate in collaborative clinical relationships with other health care providers, including physicians, other PAs, NPs, nurses, physical therapists, pharmacists, social workers, and other health care professionals. We believe that every member of every patient care team should be respected for their education, experience and skills, for the role they play in patient care, for their contributions to patient health, and for the support and leadership they give to other members of the team.
To be clear, just like physicians, NPs and other providers, PAs make and will continue to make autonomous clinical decisions every day. However, we believe that the terms ‘independent practice’ and ‘autonomy’ do not appropriately reflect our commitment to a team-based model of care. The use of these terms could suggest that we do not seek or value our relationships with physicians, nurses, or other health care providers, or that we seek to practice ‘alone’ with no accountability.”
Many PAs would feel this is a very strong, innocuous statement which supports the Academy’s commitment to team-based care and would be non-threatening to our relationship with our physician colleagues. Other more aggressive PAs may interpret this statement as the Academy’s “tiptoeing” around the issue as to not “insult” the physician organizations or “arouse the bear” so to speak. Below is a similar excerpt from the American Association of Nurse Practitioners(AANP) issue brief on Full Practice Authority:
“Full Practice Authority is occasionally referred to as autonomous practice or independence. AANP encourages nurse practitioners and policymakers to use the terms ‘Full Practice Authority’ when referring to state practice laws that regulate nurse practitioners to evaluate patients, diagnose, order and interpret diagnostic tests, initiate and manage treatment -including prescribe medications- under the exclusive authority of the state board of nursing. The terms ‘autonomous’ and ‘independence’ have been misunderstood and misinterpreted by some in the healthcare community to imply a ‘Lone Ranger’ clinician, removal of all parameters around nurse practitioner practice and equated with exclusively entrepreneurial efforts. Under a Full Practice Authority model NP’s are still required to meet educational and practice requirements for licensure, maintain national certification, and remain accountable to the public and the state board of nursing to meet the standard of care in practice and professional conduct. NPs will continue to consult and refer patients to other providers according to patient needs.”
Nothing in the AANP statement implies that NPs are not committing to practice cooperatively and collaboratively with other healthcare providers. The statement precisely outlines their scope of practice and authority, and make a commitment to remain (not become more) accountable to the public for their services.
When the House of Delegates meets this May, I would like to see the delegates consider titling this new concept with the original intent of the Academy’s Board of Directors. There is nothing wrong with the AAPA and all PAs using the same terminology that our APRN colleagues are currently using, “FULL PRACTICE AUTHORITY” (FPA). Most all states General Assembly’s do not legislate
RESPONSIBILITY they create statutes that grant AUTHORITY!!!