Full Practice Responsibility Task Force

[PAFT PRESIDENT]

https://www.aapa.org/twocolumn.aspx?id=6442451554

 

discuss.

PAFT had a major role behind the scenes in advancing this proposal and we have a board member on the task force.

[BelgianPA]

Love it! A great step for PAs if we all get behind this!

 

Super stoked!

 

 

Sent from my iPhone using Tapatalk

[LKPAC]

Long overdue.  An excellent step.

[Guest JMPA]

total garbage, refuses to consider autonomy like nps and mds have

[Reality Check 2]

total garbage, refuses to consider autonomy like nps and mds have

 

Baby steps, not barnstorming.

Play nice, no sudden moves. 

Not cowering just not threatening overtly.

[LT_Oneal_PAC]

I think it's great. It's not so far reaching that people will scoff and say we're pushing for the impossible or that we are over stepping, but lays the foundation for us to take control of our profession making future changes even easier.

[ventana]

Well done

 

Threads the needle nicely to establish that we are a member of the team, but we want to be responsible for our own professional destiny.

 

As to the comment of total garbage - I have to TOTALLY disagree - These are huge steps to be taking - although about 10 years late - but if we do not make these steps I truly beleive the profession will die a slow death..... I would suggest if you think this is truly total garbage then some reading and talking to established PAs that have owned practices, and worked at the top of their licenses and seen the true barriers to practice to learn more. As well we are not a HUGE nursing union with hundreds of thousands of members.... We have just over 100,000 PAs and many do not contribute money to our PAC or other agencies..... and this makes it next to impossible to advoacate for us..... So. Please learn more and talk to more people before you shoot down such huge advancement.

[Guest JMPA]

Well done

 

Threads the needle nicely to establish that we are a member of the team, but we want to be responsible for our own professional destiny.

 

As to the comment of total garbage - I have to TOTALLY disagree - These are huge steps to be taking - although about 10 years late - but if we do not make these steps I truly beleive the profession will die a slow death..... I would suggest if you think this is truly total garbage then some reading and talking to established PAs that have owned practices, and worked at the top of their licenses and seen the true barriers to practice to learn more. As well we are not a HUGE nursing union with hundreds of thousands of members.... We have just over 100,000 PAs and many do not contribute money to our PAC or other agencies..... and this makes it next to impossible to advoacate for us..... So. Please learn more and talk to more people before you shoot down such huge advancement.

Learn more? Talk more? obviously you turn to ignorant personal attacks. why not read the article and fully understand what it means? i do not know about you but i have been practicing with "full practice responsibility" since i obtained my medical license. how does this in any way benefit the individual PA? it detracts from the majority goal of AUTONOMY. I do not recall a single PA asking for more responsibility without autonomy. this in no way aligns with what MD and NP practice autonomy is.

[EMEDPA]

FPR means you are a team member AND no one has to sign your charts or take responsibility for you at the medical board...this is a significant improvement over the status quo and means a doc will not be afraid to hire a PA because of perceived liability...

[LT_Oneal_PAC]

If no one signs my chart/has to speak with me/see the patient first/etc, I'm legally responsible for my practice, and my ability to practice is decoupled from a physician, then I'm not sure what more you want. You could put it more bluntly, but the previous basically gives you all the same autonomy.

[EMEDPA]

also , FPR makes it easier for a PA to get a part time job, move to another state, volunteer in a medical capacity,  etc

[jwells78]

I like the idea- but there has to be means in place to ensure this FPR is bestowed upon PAs ready for the responsibility.

 

A brand-new PA out of school is not ready for it, especially one with limited prior HCE.

 

We have all seen the PA school admission requirement for HCE gradually decline, and I believe this to be a huge detriment to our career field.

 

I am behind expanding our scope and responsibility, but oversight- at least for the first few years out of school has to be there or I see problems.

[EMEDPA]

Jwells- something to remember- FPR does NOT mean a PA can't seek a consult and also does not mean that a doc or dept who hires a PA will lose the ability to tell the new grad " you work for me/us/this hospital. I want you to discuss the following XYZ cases with me for the first year you work here...."

[Guest JMPA]

more autonomy, not more responsibility without the autonomy, this hogwash is not the solution, it will be the coffin nail for the profession. It is dressed up as something good, it is a trojan horse

[rev ronin]

more autonomy, not more responsibility without the autonomy, this hogwash is not the solution, it will be the coffin nail for the profession. It is dressed up as something good, it is a trojan horse

I'm not sure where you're seeing that in what was linked, honestly.  I fail to see how this will be detrimental, even if (for the sake of argument) it ends up being ineffectual.  What do you see in it that you understand to be more responsibility?

[ventana]

JMPA

 

I am not sure you read the AAPA page

 

Your statements make no sense when you read the whole thing - are you talking about the same document that is linked in the above post

 

I honestly can say that I "thought" I was practicing at the top of my license, BEFORE owning my own practice.....

 

Then I got an education as how many little things are just a PIA when you are a PA and not an MD.  And they have ZERO relevancy to medical knowledge or skill.... they are just BS items.. see my other posts for more extensive rants on this topic.

 

I was not attacking you personally, but instead disagreeing with a posting which seemed to just throw mud, and disagree where there really is so much more to it.  I offered a suggestion for you to educate yourself more and even provided a category of people to discuss with as it seems there is some possible knowledge holes.....  yet all you do it throw a similar barbed reply back.

 

 

It truly seems like you do not understand where the AAPA task force is going, and I am offering to help explain.....

Please do the board a favor and be specific in what you are contesting and not just  make general statements 

[Guest JMPA]

"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."

Without the ability for independent practice and autonomy we have no chance to become business owners like MDs and nps. It essentially prevents one from owning an independent practice as a PA. I truly feel that if an experienced PA (note: must be experienced, maybe even pass specific boards for the specialty and have say 10 years out) wishes to practice medicine, within the same realm as a NP or MD, then we should not be restricted.

[rev ronin]

Practice ownership is state-by-state.  In Washington, it's still legal to own a practice as a PA and employ a doc to do chart review.  The Medical commission was looking into whether that was such a good idea when a couple of years ago a doc (Vancouver area, IIRC) went off the deep end and his PA/practice owner didn't report him because he would have to close down without a medical director... but nothing ever came of that.

[EMEDPA]

nothing about FPR means a PA couldn't be a practice owner, in fact it would make it easier if you don't have to be associated with a doc and pay one every month for chart review.

[True Anomaly]

"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."

Without the ability for independent practice and autonomy we have no chance to become business owners like MDs and nps. It essentially prevents one from owning an independent practice as a PA. I truly feel that if an experienced PA (note: must be experienced, maybe even pass specific boards for the specialty and have say 10 years out) wishes to practice medicine, within the same realm as a NP or MD, then we should not be restricted.

 

 

Well, you do have the option of forming your own organization and taking up the cause of complete independence.  

[jmj11]

Ownership and accountability are not related. You can own Mayo Clinic, but still be accountable to colleagues and the standard of care that my have been set by physicians who are your employees.

[overthehorizen]

total garbage, refuses to consider autonomy like nps and mds have

While I wouldn't say "total" garbage, I do agree that there is a distinctly unpleasant odor in this proposal. JMPA has hit on it squarely. We continue to behave as subservient to physicians when we have "collaboration agreements." First, no NP has a collaboration agreement. Everyone agrees that on the whole, PAs have superior training that is more rigorous than NPs yet take a back seat to NPs. We need the right to hang our own shingle. We need to demonstrate innovation in health care delivery. This cannot happen with the existing proposal. Second, the idea of "collaborative team" is a fiction. Physicians see PAs as tools to manipulate for profit. I have never met a Physician who regarded PAs as team members. Physicians have more respect for NPs than PAs BECAUSE the NP has independent practice rights. When the Physician sees the PA who "needs" a collaboration agreement, they automatically presume that the PA is inferior to the NP. So JMPA is right on the part about autonomy. Autonomy must be primary above all. I will agree that I was impressed with much of the remainder of the work done and thought the video was well produced. 

[overthehorizen]

nothing about FPR means a PA couldn't be a practice owner, in fact it would make it easier if you don't have to be associated with a doc and pay one every month for chart review.

I would like EMED to elaborate on this argument. Right now, having a "relationship" with a Physician so the PA can start a business is just an anchor around the neck of the PA. The Physician adds no value. The Physician for "chart review" is like hiring your brother-in-law because your wife asks you to do it. You know he doesn't generate any value but if you want to keep getting laid at home, you have to throw money away at the office. 

[ventana]

Seems to be some misunderstandings going on so I have posted and highlighted some sections

 

 

 

Task Force Request for Feedback

The Joint Task Force on the Future of PA Practice Authority has engaged in its preliminary deliberations, and seeks feedback from the PA community regarding its suggestions for AAPA policy.

After 50 years, we believe that the PA profession has demonstrated a commitment to competent and quality care for our patients. It is natural for our profession to seek to define its future. After initial deliberations, the Task Force believes the profession should consider and commit to a process that gives PAs “Full Practice Authority and Responsibility”. In this process we seek to make the PA profession and individual PAs more accountable, preserve our positive relationship with physicians, and, by decreasing unnecessary administrative burdens on physicians, PAs and our employers, increase access to care for patients.

In order to realize PA Full Practice Authority and Responsibility, AAPA would have to adopt policy changes and take action to:

• Emphasize our profession’s continued commitment to team-based practice.
• Support the elimination of provisions in laws and regulations that require a PA to have and/or report a supervisory, collaborating or other specific relationship with a physician in order to practice.
• Advocate for the establishment of autonomous state boards, with a voting membership comprised of a majority PAs, to license, regulate, and discipline PAs.
• Ensure that PAs are eligible to be reimbursed directly by public and private insurance.

What do we mean by Full Practice Authority and Responsibility?

We mean that, collectively, PAs have the Authority and Responsibility, as a majority of the voting members of an autonomous state PA licensing board, to:

• Define and regulate PA licensure
• Define and regulate PA practice
• Determine and enforce through disciplinary action PA practice standards

We mean that, individually, every licensed PA has the Authority and Responsibility to:

• Practice as a member of health care teams that include other PAs, physicians, NPs, nurses, pharmacists, physical therapists, social workers, and others
• Practice to the top of their own education, training, experience and competency
• Recognize the limits of their knowledge and abilities, and know when a patient’s condition requires consultation with and/or referral to other qualified healthcare providers
• Adhere to the regulatory requirements of the PA board
• Adhere to standards of care, document this care, prescribe and order appropriately, and complete and sign all documents required for patient care, disability, insurance, medical leave, and medical necessity
• Accept liability for the care they provide
• Bill public and private payers directly for the services they provide, as appropriate

How is Full Practice Authority and Responsibility different from “independent practice” or “autonomy”?

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.

- See more at: https://www.aapa.org/twocolumn.aspx?id=6442451554#sthash.GTlmatpv.dpuf

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I think it is important to read the entire document to get a feel for this is going as certain lines can be taken out of context.

 

My read is that we are taking the political high road, agreeing that we are part of a team (as opposed to NP) and that we respect this team.  BUT that we need to be fully responsible for our own selves - MEANING no relationship mandated with a doc - so SP/CP or other agreements.  Also, is specifically states that PA should be able to do EVERYTHING and sign EVERYTHING in accordance to their own education....

 

to be more clear - No where does it advocate for ongoing formal links to any other profession - but instead says "let us stand on own own as valuable part of the health care team"  It is stating to remove all barriers to practice, and requirements for Doc supervision.....

 

 

That is my read, and hence why I do not see where other people are saying this is pure garbage?

[overthehorizen]

Seems to be some misunderstandings going on so I have posted and highlighted some sections

 

 

 

Task Force Request for Feedback

The Joint Task Force on the Future of PA Practice Authority has engaged in its preliminary deliberations, and seeks feedback from the PA community regarding its suggestions for AAPA policy.

After 50 years, we believe that the PA profession has demonstrated a commitment to competent and quality care for our patients. It is natural for our profession to seek to define its future. After initial deliberations, the Task Force believes the profession should consider and commit to a process that gives PAs “Full Practice Authority and Responsibility”. In this process we seek to make the PA profession and individual PAs more accountable, preserve our positive relationship with physicians, and, by decreasing unnecessary administrative burdens on physicians, PAs and our employers, increase access to care for patients.

In order to realize PA Full Practice Authority and Responsibility, AAPA would have to adopt policy changes and take action to:

• Emphasize our profession’s continued commitment to team-based practice.
• Support the elimination of provisions in laws and regulations that require a PA to have and/or report a supervisory, collaborating or other specific relationship with a physician in order to practice.
• Advocate for the establishment of autonomous state boards, with a voting membership comprised of a majority PAs, to license, regulate, and discipline PAs.
• Ensure that PAs are eligible to be reimbursed directly by public and private insurance.

What do we mean by Full Practice Authority and Responsibility?

We mean that, collectively, PAs have the Authority and Responsibility, as a majority of the voting members of an autonomous state PA licensing board, to:

• Define and regulate PA licensure
• Define and regulate PA practice
• Determine and enforce through disciplinary action PA practice standards

We mean that, individually, every licensed PA has the Authority and Responsibility to:

• Practice as a member of health care teams that include other PAs, physicians, NPs, nurses, pharmacists, physical therapists, social workers, and others
• Practice to the top of their own education, training, experience and competency
• Recognize the limits of their knowledge and abilities, and know when a patient’s condition requires consultation with and/or referral to other qualified healthcare providers
• Adhere to the regulatory requirements of the PA board
• Adhere to standards of care, document this care, prescribe and order appropriately, and complete and sign all documents required for patient care, disability, insurance, medical leave, and medical necessity
• Accept liability for the care they provide
• Bill public and private payers directly for the services they provide, as appropriate

How is Full Practice Authority and Responsibility different from “independent practice” or “autonomy”?

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.

- See more at: https://www.aapa.org/twocolumn.aspx?id=6442451554#sthash.GTlmatpv.dpuf

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I think it is important to read the entire document to get a feel for this is going as certain lines can be taken out of context.

 

My read is that we are taking the political high road, agreeing that we are part of a team (as opposed to NP) and that we respect this team.  BUT that we need to be fully responsible for our own selves - MEANING no relationship mandated with a doc - so SP/CP or other agreements.  Also, is specifically states that PA should be able to do EVERYTHING and sign EVERYTHING in accordance to their own education....

 

to be more clear - No where does it advocate for ongoing formal links to any other profession - but instead says "let us stand on own own as valuable part of the health care team"  It is stating to remove all barriers to practice, and requirements for Doc supervision.....

 

 

That is my read, and hence why I do not see where other people are saying this is pure garbage?

I read this and was impressed with your vision. I am stuck with one question for you Ventana. Your profile states "Moderator/Practice Owner." How will this proposal get the monkey off your back so you can run your practice without paying a Physician for the right to hang your own shingle. Are Physicians who operate practices paying a PA a monthly fee for a right to practice. Do they pay that fee to someone who essentially does nothing but satisfy a protectionist policy to keep others out of their practice space by raising barriers to entry? Sincerely, I ask you to address this on a street level.