Making "Physician Associate" a protected term

[Febrifuge]

MN statute 147A.03 is the section of law which specifies who can use terminology that identifies us as PAs. It's not terribly long or complex - here's the 2012 version, which is the most recent:

 

 

Subdivision 1. Protected titles.

No individual may use the titles "Minnesota Licensed Physician Assistant," "Licensed Physician Assistant," "Physician Assistant," or "PA" in connection with the individual's name, or any other words, letters, abbreviations, or insignia indicating or implying that the individual is licensed by the state unless they have been licensed according to this chapter.

 

Subd. 2.Health care practitioners.

Individuals practicing in a health care occupation are not restricted in the provision of services included in this chapter as long as they do not hold themselves out as physician assistants by or through the titles provided in subdivision 1 in association with provision of these services.

 

Subd. 3.

[Repealed by amendment, 2009 c 159 s 16]

 

Subd. 4.Sanctions.

Individuals who hold themselves out as physician assistants by or through any of the titles provided in subdivision 1 without prior licensure shall be subject to sanctions or actions against continuing the activity according to section 214.11, or other authority.

 

 

...see anything about that which could use a tweak?

 

I did, but it took a while.

 

Without getting into a big debate about whether "Physician Assistant" is the right terminology, or whether it would be practical or desirable to change our title at some point, I can't help but noticing that under current state law, there is absolutely nothing keeping some unqualified scam-artist selling questionable treatments from printing up business cards using the term "Physician Associate." Even if you don't agree that 'Associate' should be a title we use, I think you'll agree it's one we don't want just anyone to be able to use, either.

 

And that's what I had in mind when I wrote to my state Representative and state Senator. Here's what I sent:

 

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Introduction and Background

 

I am a Physician Assistant, a "mid-level" medical practitioner, living in [city] and working in [City]. I practice medicine autonomously -- but in collaboration with, and with the benefit of oversight from, an MD. I work for [Practice Name] at the [specific location]; I am the solo provider when I'm on duty. My profession has been growing for the past few decades, and I like to think that as a PA, I'm a part of the solution when it comes to dealing with the spiralling costs of health care, and the lack of access to qualified providers. I'm happy with my choice to become a PA, and proud of the work I do.

 

One of the issues facing us PAs as a group is the idea that our title, and particularly the word "Assistant," can give a skewed impression of what we do and how we do it, and cause needless confusion about our qualifications and abilities. Because other industries feature familiar and similar-sounding titles like "Executive Assistant" or "Administrative Assistant," there is often the connotation that we are somehow an "assistant to a physician," if you follow my meaning, when in fact we are medical practitioners in our own right. Even within healthcare, there are titles like "Medical Assistant" or "Nursing Assistant," which denote important support roles, but not licensed providers of health care.

 

In fact, I hear the term "Physician's Assistant" (with the apostrope-s that denotes ownership) used as often as the correct version. Unfortunately, that is not at all accurate -- that would be a Medical Assistant, the person who might check your vital signs or draw your blood. We PAs are not physicians, and are careful to avoid confusion about that fact, but we are fully qualified to provide medical care, within the scope of practice defined by the law and our individual agreements with our supervising physicians.

 

It is my custom to always identify myself as a "PA" or "Physician Assistant" when meeting patients, but on those occasions when there is further discussion about what a PA is or does, I like to add some wording to acknowledge that "sometimes the term used is Physician Associate." I have found, in general, that this helps clear up confusion about my role and purpose, and it also appears to engender a better sense of confidence from patients about my education and qualifications.

 

This alternative title is not something I made up; in fact, in the earliest days of my profession, when it was being introduced at Duke University in the mid-1960s, "Physician Associate" was the original title. The Master's degree granted by Yale University, one of the oldest PA training programs in the country, comes from what has always been and is still called the Physician Associate program.

 

The Problem

 

I'm writing today not to wade into the thicket of complexity that might accompany an attempt to change my official title from "Physician Assistant" to "Physician Associate," as that is something for the proper PA professional associations to consider in due course. Rather, I would like to close a loophole in the Minnesota statutes that may relate to the topic, and more importantly, could potentially make the confusion about my title worse in the future. Part of the long and gradual process of putting "Physician Associate" on an equal footing with "Physician Assistant" is making sure that the alternative title has the same protection as the current one, and cannot be used by anyone except a licensed, certified PA.

 

Presently, the PA Practice Act that governs my profession ( https://www.revisor.mn.gov/statutes/?id=147A ) includes a short list of titles that are protected, and are barred from use by anyone who has not satisfied the applicable educational and professional requirements. In the same way there are strict limits on who can call themselves a "medical doctor" or "physician," the law specifies who can use terminology pertaining to my profession. The pertinent section is found in https://www.revisor.mn.gov/statutes/?id=147A.03 . As you will see, even the simple abbreviation "PA" is protected, and cannot be used by anyone who is not a certified, licensed PA. I am glad for the protection this law gives, and confident that the state has my best interests, and the interests of my patients, in mind by providing this protection.

 

Perhaps it is an unlikely possibility, but I am concerned that "Physician Associate," a term that has been in use for as long as "Physician Assistant" and is in fact used today at Yale and other places, does not have that same protection in Minnesota. I'm no lawyer, but a close reading of the statute suggests to me that a person who used the title "Physician Associate" in the course of fraudulently representing him/ herself as a medical practitioner would not be subject to any penalty under that particular law.

 

Regardless of whether a profession-wide change to "Physician Associate" (or even just the embracing of the term as an alternative, equal title) is practical or desirable, I think you'll agree that leaving the "Associate" title open to this sort of potential for abuse could, in theory, create further confusion and expose the people of Minnesota to a non-trivial risk of fraudulent and/ or unsafe medical care.

 

The Solution

 

I seek a very simple change to MN 147A.03: the term "Physician Associate" should be added to the list of protected titles in Subdivision 1. This small thing will help to ensure that in the future, if and when the term "Physician Associate" gains more widespread use as either a co-equal title with "Physician Assistant" or a substitute for it, there will be no interval during which the term is open to fraud or abuse, and it will be as protected then as "Physician Assistant" is at the present time.

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I don't represent MAPA (truth be told, I'm not even a member), I'm just a private citizen with a concern about our profession. If you agree that there's potential for abuse here, and especially if you like the idea of "Physician Associate" at least being a title we should consider being able to use at some point, I'd encourage you to use the district finder at...

 

http://www.leg.state.mn.us/leg/districtfinder.aspx

 

...to find your own state legislators and write your own version of this letter. Feel free to cut and paste the sections where the law is referenced, or any of the bits you think are helpful and appropriate. Be sure to get specific about where you live and where you practice.

[rcdavis]

Most EXCELLANT..

 

Brings up the vexing issue.. Is the term physician associate trademarked?

 

By Emory? Or Yale?

 

Hmmmm

 

PAFT???

[Febrifuge]

I don't know that one can really trademark a title like that, unless it's something entirely made up and not otherwise a word -- hello, Realtors !

 

All I know about Yale is, their program is called "Physician Associate" and presumably that's what it says on the diploma, and it doesn't seem to be an issue anywhere.

[LT_Oneal_PAC]

If Paris Hilton can trademark "that's hot," anything can be.

[EMEDPA]

most excellent Feb. will forward to the board of PAFT.

[andersenpa]

I like it. PAFT will start chewing on this.

[EMEDPA]

I like it. PAFT will start chewing on this.

already forwarded to the board.

[Febrifuge]

Groovy. Glad to be helpful.

[Guest Paula]

Most EXCELLANT..

 

Brings up the vexing issue.. Is the term physician associate trademarked?

 

By Emory? Or Yale?

 

 

Hmmmm

 

PAFT???

 

I vaguely remember someone saying that NCCPA has gotten the right to use the title Physician Associate and trademarked it for their use, when the time comes that our title changes. Was I dreaming this? I can't even remember where I heard this. Could be a rumor. ALso, the term/title Physician Associate was patented by the first AAPA, and the documents are on the PAHX site. So,we already have the term patented and it is ours!

[Febrifuge]

I vaguely remember someone saying that NCCPA has gotten the right to use the title Physician Associate and trademarked it for their use, when the time comes that our title changes. Was I dreaming this? I can't even remember where I heard this. Could be a rumor. ALso, the term/title Physician Associate was patented by the first AAPA, and the documents are on the PAHX site. So,we already have the term patented and it is ours!

That is good news -- so now we just need to make sure state laws don't have the same loophole that Minnesota does, where "Physician Associate" just goes completely without mention and thus without protection.

 

I really don't think it requires a lot of coordinated lobbying action, just some attention and individual letters and emails from PAs who have a concern. It's not like it would be a tough bill to write, or a controversial vote to make.

[Guest Paula]

Do patents expire? I like Febrifuge's idea....thinking outside the box. Many states have similar language in their PA laws about title protection. Believe me, someone (or some governing body) will make it controversial. Betcha can't guess who?

[Hemegroup]

Sorry, I thought I was on the PA forum.

[EMEDPA]

Do patents expire? I like Febrifuge's idea....thinking outside the box. Many states have similar language in their PA laws about title protection. Believe me, someone (or some governing body) will make it controversial. Betcha can't guess who?

 

An Association Promoting Apathy?

[Guest Paula]

and probably A Moronic Association?

[Guest Paula]

Or perhaps the state Bored of Maniacs?

[andersenpa]

American academy of paternalistic attitudes

[EMEDPA]

American academy of paternalistic attitudes

or american academy of piddly autonomy

[Febrifuge]

UPDATE:

 

My state senator is pretty on the ball. I sent my emails last night, and got this sometime before I got up today:

 

Dear Mr. [Febrifuge],

You make a good point. I will visit with Senate counsel and see if this issue has come up before in the medical field or similarly in other professions.

Ann Rest

Sent from my iPad

Senator Ann H. Rest

235 State Capitol

St Paul MN 55155

 

She cc'd a couple of people who must be Senate staffers on the response, too. Pretty cool for a state senator, right?

[greenmood]

Any word since?

[Febrifuge]

Oh wow, sorry, this got past me and turned into an old thread. The update is... not great.

 

My state Rep actually already knew the guy who's the lobbyist/ consultant for the state PA association. They had worked together in city government. Both my Rep and I were optimistic.

 

Then my Rep wrote me back, and copied me on what the lobbyist had said. Basically, the gist of it was no way, MAPA would hate this. Apparently, MAPA polled its members within the past few years sometime, and they didn't have enough interest in the "Associate" title for them to feel comfortable advocating for it.

 

But wait, you say -- nobody's trying to advocate for a change, right? Right. And my Rep got that too. So he asked. And the lobbyist said things like it "might be confusing" and "nobody's trying to use 'Associate,' so there's no need," and at some point, if the interest is there for a switch to "Associate," then that might be the time to address it.

I got discouraged, thanked my Rep for his time, and he was very cool about it. He's newer to state-level politics, and said he has been surprised that things that seem like common sense, or like they should be slam-dunks, suddenly hit brick walls like this. It happens, it's not unusual, but that doesn't mean it makes sense.

 

Then I joined PAFT.

 

As of now, I have yet to join MAPA. Although, doing so might give me a little more of a platform for banging this drum, if I decide to make a case out of it again...

[Guest Paula]

@Febrifuge:  It might be worth rejoining MAPA for one more year as the times are changing.  PAs will need to be given more autonomy if the system is going to work with ACA implementation........thus leading to protection of our title including the Associate part of it. 

 

Michigan has a bill to delete supervision and delegation from our laws and is looking to give MI PAs independent prescribing rights. Physicians are still involved as part of the team and required but we have taken a step forward for more autonomy.  

 

Call the representative and see what the temperature gauge is now in MN for PA practice changes.  Then find fellow supporters....I know they are out there and are afraid of coming forward until someone else does.