jdtpac Posted March 14, 2017 Share Posted March 14, 2017 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!!! Link to comment Share on other sites More sharing options...
Noreaster Posted March 14, 2017 Share Posted March 14, 2017 Excellent point and well-written and intelligible, jdtpac. It occurred to me, as I read through you post, that it would make a lot of sense to keep language similar and also very clear and, yet, forward-thinking as to how things will proceed with state laws. We PAs have had enough ambiguous language in our profession...even our title--itself--is ambiguous to MANY. I second the motion you suggest, wholeheartedly. I am going to write the AAPA actually. Thank you, jdtpac, for sharing your thoughts. Link to comment Share on other sites More sharing options...
jdtpac Posted March 20, 2017 Author Share Posted March 20, 2017 Noreaster, Thank you for the kind words. I’m glad you appreciated my comments. Unfortunately, I guess I didn’t get my points across to any other PAs, based on the lack of replies. I realize I’m one of the dinosaurs and it’s now the younger PAs time to decide what they want the future direction of the profession to be. Again, I truly believe words matter, and they have always mattered when we have try to emphasize what we are, who we are and what services we can provide to increase access to care. Take care. Link to comment Share on other sites More sharing options...
Moderator ventana Posted March 20, 2017 Moderator Share Posted March 20, 2017 Jdtpac Very good points A little long in the explaination likely cuts down on replies But I like FPA better!! Link to comment Share on other sites More sharing options...
jdtpac Posted March 21, 2017 Author Share Posted March 21, 2017 Jdtpac Very good points A little long in the explaination likely cuts down on replies But I like FPA better!! Ventana, I understand, I realize it was a little long but I wanted to get my point across and especially utilize the quotes from both the AAPA and AANP. Thanks for your comment and I wish more people like you would like the FPA better. Link to comment Share on other sites More sharing options...
physasst Posted March 24, 2017 Share Posted March 24, 2017 Great discussion John. I agree with you. Hope you are well. Give your wife a hug from me. Kindest, Mike Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted March 24, 2017 Share Posted March 24, 2017 Noreaster, Thank you for the kind words. I’m glad you appreciated my comments. Unfortunately, I guess I didn’t get my points across to any other PAs, based on the lack of replies. I realize I’m one of the dinosaurs and it’s now the younger PAs time to decide what they want the future direction of the profession to be. Again, I truly believe words matter, and they have always mattered when we have try to emphasize what we are, who we are and what services we can provide to increase access to care. Take care. I like being this kind of dinosaur. We also have to keep in mind that our mindset during training and the next decade or two of clinical practice were totally different than where the newer PAs are coming from. Link to comment Share on other sites More sharing options...
Guest JMPA Posted March 24, 2017 Share Posted March 24, 2017 i concurr Link to comment Share on other sites More sharing options...
Noreaster Posted March 24, 2017 Share Posted March 24, 2017 you, (the "dinosaurs") are not respected NEAR enough!!! I, however, respect you guys...a lot ! By the way, I did write the AAPA in support of making language of the evolutionary steps, i.e., FPA, as simple, clear, and non-ambiguous as possible! Imagine the nightmare of trying to get the ambiguities cleared up with insurances, Medicare/Medicaid, etc... Streamline, simple, non-ambiguousness, clarity, and NOT being 'lesser' of a practitioner than an NP in the eyes of anyone, PLEASE! Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted March 24, 2017 Share Posted March 24, 2017 you, (the "dinosaurs") are not respected NEAR enough!!! I, however, respect you guys...a lot ! By the way, I did write the AAPA in support of making language of the evolutionary steps, i.e., FPA, as simple, clear, and non-ambiguous as possible! Imagine the nightmare of trying to get the ambiguities cleared up with insurances, Medicare/Medicaid, etc... Streamline, simple, non-ambiguousness, clarity, and NOT being 'lesser' of a practitioner than an NP in the eyes of anyone, PLEASE! In honor of your kind words I will refill your Zomax prescription, inject your lumbar HNP with chymopapain, and get you some Talwin NX dropped off by the drug rep without having to log it in and document dispersement. Link to comment Share on other sites More sharing options...
jdtpac Posted March 24, 2017 Author Share Posted March 24, 2017 Great discussion John. I agree with you. Hope you are well. Give your wife a hug from me. Kindest, Mike Mike, thank you. Diane says hello and I definitely will give her a hug. I hope to see you in Las Vegas. Take care Link to comment Share on other sites More sharing options...
Guest Paula Posted March 25, 2017 Share Posted March 25, 2017 jdt: You have a point and I think I agree with you. The new phraseology of Optimal Team Practice does not sit well with me either. I'm anxiously awaiting the task force's revision and hoping they have preserved the FPA. I've always been 100% responsible for my patients and teach the PA students I precept to do the same. Link to comment Share on other sites More sharing options...
jdtpac Posted March 25, 2017 Author Share Posted March 25, 2017 jdt: You have a point and I think I agree with you. The new phraseology of Optimal Team Practice does not sit well with me either. I'm anxiously awaiting the task force's revision and hoping they have preserved the FPA. I've always been 100% responsible for my patients and teach the PA students I precept to do the same. Paula, Thank you for agreeing with me, I also agree with you, I do not like the new phraseology of OPTIMAL TEAM PRACTICE. I believe you and several other members of this forum are currently on the PAFT Board of Directors. The PAFT has a position paper on their website to support FPAR, which I’ve read and totally agree with most all the concepts, except for the title of the concept (FPAR). I realize PAFT originally supported the concept Full Practice Responsibility (FPR) that was introduced by AFPPA when they submitted resolution 2016-A-08 to the 2016 AAPA House of Delegates (HOD). I respectfully request that you share your opinion on Full Practice Authority (FPA) with your fellow members of the PAFT Board. When the topic of FPAR is debated at the 2017 AAPA HOD, my hope would be that PAFT, and others on this forum planning to attend this meeting, will support the original and more appropriate title for the PA profession’s quest for an expanded scope of practice and independent regulation, FPA and not FPAR! Take care. Looking forward to seeing you and other members of PAFT at the AAPA Conference this May in Las Vegas. Link to comment Share on other sites More sharing options...
Guest Paula Posted March 25, 2017 Share Posted March 25, 2017 Jonathan, I am unable to attend AAPA conference this year. Hope to see you all next year where we will be sure to discuss other hot topics........ Link to comment Share on other sites More sharing options...
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