AAPA Elections Still Relevant?

[Jim Anderson]

I'm running for the AAPA Board (Secretary-Treasurer) in the 2014 elections, which start April 1. The numbers of members who vote continues to shrink. I think having members elect the board is important, and also think that all PAs have a responsibility to participate in professional efforts like the AAPA, specialty orgs, state chapters etc. I contribute blog posts from time to time for Clinical Advisor (click on opinion/blogs tab), and wrote about this issue recently there. I'd love to hear what other PAs think. For non-members, I want to learn more about what keeps you from joining, and from members, I'd like to hear more about how you see the AAPA, and how it could better serve your needs. BTW, here is my Facebook campaign page, with more about my platform and goals 

 

[Boatswain2PA]

I was just about to join right before last year's IMPACT. Then a certain neurosurgeon, one of the best in the world and the recipient of the Paragon award, was disinvited to the conference because the AAPA disagreed with his political beliefs.

 

Add that to their following the AMA's support of the Affordable Care Act (Obamacare) and it became apparent to me that the values of the AAPA is incongruent with my values.

 

I am a member of a specialty organization that strives to improve the role of PAs in the specialty without caving in to political correctness.

[EMEDPA]

The ability of the AAPA staff(who are not elected) being able to set the agenda for what the house of delegates can discuss is just wrong.....several amendments appropriately submitted for discussion were passed over as inappropriate for discussion at a recent HOD....I am still a member( DFAAPA in fact) and I think AAPA has made some appropriate progress over the past few years but there is still significant room for improvement....especially in the public relations arena.....I'm tired of people not knowing what a PA..."educating patients one at a time" as a strategy isn't working, we've tried it for almost 50 years and the only folks who consistently know what a pa is are military or former military....we need magazine ads, late night radio ads, etc....

[UGoLong]

I joined AAPA as an affiliate member when I started thinking of becoming a PA 15 years ago, then as a student member,  and I still belong as a full member. For better or worse, I feel that you need to support your professional organization if you hope to get anything done. I am, however, not particularly impressed with their track record over that period of time.

 

I have had conversations with AAPA staff and remain dissatisfied with their concept of more or less "running our own race" when it comes to establishing the profession to be at the very least an equal to that of NPs. Focusing on the long, hard push of getting all 50 state legislatures to adopt all 6 of the central goals of PA practice doesn't do it for me. In the interim, we have fewer employment opportunities in many parts of the country. My boss can only have 2 PAs, but as many NPs as he'd like. I can't work when he is more than an hour away, but an NP can. Even the NPs here don't understand why that is. 

 

Working through government for change is necessary but not sufficient. As so many national trends have illustrated, laws change slowly until there is some sort of tipping point. That will take public awareness of who we are, which -- so far -- there clearly is not.  

 

I endorse EMEDPA's statement.

[burnpac]

Add that to their following the AMA's support of the Affordable Care Act (Obamacare) and it became apparent to me that the values of the AAPA is incongruent with my values.

 

The AAPA never formally supported the ACA. We did in fact work tirelessly with the legislative process to ensure that PA issues were included and our concerns were address. In the midst of HCR, it would have been irresponsible for the AAPA to not be at the table to address concerns and legislative issues that we have been working on as a profession for decades prior to the push for the ACA.

[burnpac]

The ability of the AAPA staff(who are not elected) being able to set the agenda for what the house of delegates can discuss is just wrong.....several amendments appropriately submitted for discussion were passed over as inappropriate for discussion at a recent HOD....I am still a member( DFAAPA in fact) and I think AAPA has made some appropriate progress over the past few years but there is still significant room for improvement....especially in the public relations arena.....I'm tired of people not knowing what a PA..."educating patients one at a time" as a strategy isn't working, we've tried it for almost 50 years and the only folks who consistently know what a pa is are military or former military....we need magazine ads, late night radio ads, etc....

 

AAPA staff have no role in setting the agenda for the HOD. This is the sole perview of the Speaker, and the House Officers. Resolutions have to be in order, germane, and consider an issue or issues that are under the jurisdiction of the House to make in on the agenda. These are the only reasons that a resolution is rejected for consideration. Even if a resolution is rejected at the submission deadline by the HOs, this can be appealed to the HOD with the late resolution process.

[Jim Anderson]

These are all really rich replies to my inquiry about how PAs feel about the relevance of the AAPA elections.

 

Certainly the emerging role of "staff" in the running of the organization is somewhat controversial. Like Steve Hanson points out, it is the elected and PA "house officers" (Speaker, First Vice Speaker, Second Vice Speaker) who are charged with processing resolutions. My experience with them has been that they are very supportive of all resolutions being moved forward, and go out of their way to help resolution-writers get their ideas to HOD. One new role for staff, and when that I think you and I disagree about Steve, is the relatively new role of staff in sending the staff and staff leadership perspective about resolutions to all HOD delegates before HOD starts. Some of the "staff leadership perspectives"have been very flawed and inaccurate, such as the staff communication about the resolution a few years ago to support increased access to naloxone to prevent heroin overdose. Another controversial point about the new "staff input" is that in the past, there has been an somewhat informal rule against "pre-testimony," or lobbying for or against resolutions before HOD. The idea was to make sure that the process and discussions at HOD really mean something, and that it's not all decided before delegates even show-up. Having staff send out opinions pre-HOD certainly runs counter to that.

 

AAPA staff leadership and the Board have been talking for a few years about using the book "Race for Relevance" as a road map to changing how the organization works, particularly related to the role of PAs and staff. It's a book by and for organization management professionals, and some of it is very common-sense and insightful, but some of it also describes a staff-driven model of running and organization that would indeed be a radical change for the association. The chapter about committees is linked here, and I've highlighted the text that I found the most alarming about the need to move to staff-run models. The AAPA Board proposed to eliminate almost all of the PA-led committees last year, and caused quite a stir at HOD. In my perspective, moving away from a PA-led structure has been a gradual process over several years, and has greatly contributed to members disengagment and lower voting turnout. I think an aggressive effort to re-engage members in leadership tasks could go a long way to bringing voters back. That's certainly a high priority for me if I get elected in the April election.  

[Guest Paula]

I am not an AAPA member any more and will not join again.  I feel completely left out in the cold as a rural PA and rural issues are not addressed adequately. The straw that broke the camel's back for me was the failure for PAs to be recognized as Eligible Professionals for the HITECH act.  AAPA must have been asleep at the wheel and did not pay attention to detail, thus PAs left behind and classified as "lesser" than the other EP's.  The partial fix was woefully inadequate and I still do not qualify as an EP in the rural FQHC I practice at.   My clinic manager/director announced that PAs will not be considered for employment any longer for this very reason and we have an opening advertising for an NP now. We are now reaping the consequences and I can't help but think there are more like me out there who are being discriminated against because of these restrictions.

 

One of the original focus of the PA profession was to  fill the need for medical providers in underserved areas and yet we have so many practice barriers that will keep PAs out of the rural areas.  I do not see AAPA as a forward thinking organization and they do not have the ability to be politically incorrect or the insight how to support PAs in this modern day of medicine. 

 

I am not in support of the 6 key elements for PA practice and fully support the PAFT organization (of which I am a delegate-at-large) for the Highest Level of PA Practice.  I believe the practice model of "supervised and dependent practitioner" is antiquated and does not make sense for this profession any longer.  AAPA has not yet seen the light on this.  

 

Other issues that I think AAPA wades into and makes statements about are the social construct issues (abortion, LGBT,  guns, violence, death penalty, conversion therapy, supporting the American Academy of Pediatrics statements of birth control for 12 year olds, etc.) and they shouldn't. After reading the policy and position papers on these issues I cannot support the organization.  Perhaps they have backed off on their stance on these issues or they are buried in the archives but I have read every one and disagree with most. 

 

While Steve says AAPA never formally supported the ACA it gave the essence of support when PAs were photographed with the President and blasted out on the AAPA marketing sites and journals, etc.  It soured me. Plus, when Kathleen Sebelius and President Obama still cannot pronounce our title correctly, something is terribly wrong.  Not even the top echelon of government have a clue who we are.  Our branding is an abject failure. 

 

Now on a happier note:  I still love this awesome career!  I am now adequately purged.

[Jim Anderson]

Paula, that is an action-packed post! :) I do agree with a few things you said, particularly the need to enhance the public image of PAs, and to move from "supervising" to something like the VA did, which is "collaborative." I applaud your committment to enhanced utilization as reflected by your involvement in PAFT. But I don't understand why you think AAPA, or really the PAs who the AAPA represents, should not care about social causes of poor health. If poverty causes poor health, then we should fight poverty. If the evidence says that X causes disease, morbidity and mortality, then I've never understood how a PA, or any medical practitioner, can just pick and choose which evidence we embrace. I don't see how we can say, "OK, I will follow the evidence that says smoking kills people and work to have my patients stop smoking, but I will ignore the evidence that says that LBGT patients are not treated equally, that says that education about guns and violence reduces morbidity and mortality. I just don't see how we can say "I reject that evidence, but I embrace that evidence." 

[Keepitrural]

A fellow PA just sent me a copy of the following letter that was sent to the AAPA. It seems to fit with the current topic. 

 

 

I am still debating whether to renew or not despite the fact that I have been a member since 1977. It seems that almost every time I get a renewal statement the price is higher. In addition I have seen little progress in some critical issues like the ability to order durable medical equipment and hospice and home health services. It seems that many of our gains in recent years have been "me toos" after the NPs have succeeded in gaining them first. I do understand that they have a bigger lobby but the number of NPs being hired in preference to PAs because of their independent status is getting scary. I think the time has come for PAs as a profession to do some serious rethinking in terms of our dependent status. I realize that this scares everyone. "What would the docs say?" response ignores the fact that the docs are the ones preferentially hiring NPs. The issue of a name change of our profession from assistant to associate had over 6000 signatures turned in last year in an attempt to get a hearing before the HOD to no avail. If I remember correctly that is about double of the historical number who vote in AAPA elections. As the years have gone on I have seen the same names in all elected positions, names put forth by the nominating committee. It is very difficult to self nominate and the committee doesn't seem to look beyond a tight circle of folks. I have zero interest in the PA Professional journal and would just as soon not receive it yet I have to pay to support it. I have seen things like the lovely lapel pins sent to all members which was met with derision among many members and was, in my opinion, a total waste of members money. The best thing I have seen come out of AAPA recently was the reduced subscription rate to the Family Medicine review cme, 60 hours of credit for $199.99.
AAPA needs to make serious changes if they want to survive as an organization and PAs to survive as a profession. I will be delaying longer in my renewal while I debate how useful AAPA still is.

[jmj11]

I've shared my story before and decided to delete it as not to whine about something that happened a long time ago,

[Guest JMPA]

Simply put, I do not feel the need to join an organization that ignores the important issues. Unfortunately the AAPA does not give the impression that it actually represents the PA professionals. Aside from all the above stated issues, which are quite serious, I was out right disgusted when they turned their back to 6000 signatures. I'm quite happy with PAFT and will only support PA organizations that are 100% for PAs and not outside interests. Until AAPA can "sell themselves" as truly looking out for the PAs I will direct my time, money and energy elsewhere.

[Jim Anderson]

This is certainly a tough crowd! :) Sad to hear about the strongly held negative feelings/experiences. Hoping to look for ways to reconnect with those who have left. I'm still interested though in hearing from others who are members, who aren't upset with the AAPA, who don't feel disenfranchised, and what they think of AAPA elections and how they might be made more relevant.

[GetMeOuttaThisMess]

I have never had a problem with AAPA, though I also never felt that I got my money's worth out of them either.  Member from '81 through late '90's maybe.  I agree that they've appeared to have ignored major issues time and time again.

[EMEDPA]

This is certainly a tough crowd! :) Sad to hear about the strongly held negative feelings/experiences. Hoping to look for ways to reconnect with those who have left. I'm still interested though in hearing from others who are members, who aren't upset with the AAPA, who don't feel disenfranchised, and what they think of AAPA elections and how they might be made more relevant.

I really appreciate you reaching out and making contact here on the forum. aside from you and Steve Hanson, we have had very little input from aapa leadership here on the largest pa forum on the net despite repeated requests for discussion.

the issue I think for most is not that aapa elections are not relevant but that the aapa doesn't change direction from year to year regardless of who is on the board. there have been some changes over the past 2 years but these I believe are reactionary based on loss of membership. until we get a real PR campaign going the aapa will continue to hemorrhage members every year. we have been asking for this for over 20 years and still have yet to see much aside from the occasional article. time to put some money in the game and stop relying on free advertising via the occasional pa on a talk show, etc.

I'm not talking about a superbowl ad but some ads in health magazines would be nice, maybe some late night radio and tv ads. most americans still think we are medical assistants. until that changes we have a MAJOR issue as a profession. our govt apparently doesn't even think we are worthy of being compensated for emr use, etc because we "work for doctors". fundamentally we need to be recognized as providers on our own merits who work in collaboration with physicians. I am not in favor of full independence as some on this board are but I think we need to be given a bit more latitude by state medical boards and others who oversee us. we are good at what we do. we are highly educated. someone out there who matters needs to say that so that america listens. the only mention of PAs in the state of the union both got our title wrong and cast an unintended aspersion against us by highlighting the case of a pa who was made to sound like she is on welfare and public assistance. not the image we want out there.

with regards to aapa stands on public health issues, I understand why most of these make sense(decrease gun violence, increase access for minority groups, etc) and have no issue with that.

[ventana]

hummm

 

cost AAPA being asleep at the wheel for HITECH funds cost ME PERSONALLY almost $40,000

 

Would you want to support an agency that forgot about you?

 

With a business degree and a lot of insurance back ground I can see we are just barely holding our heads above water.... and yet the AAPA goes and fights little battles at the state level.  But totally misses the boat at the national level.  Ignoring and special interest politics to push to the side a 6,000 signature petition does not help.  Leaving us out of hitech, does not help, never leading the way (only following the NPs) does not help.

 

Never again will there be such a time of dynamic change in health care - if AAPA does not get it in gear (we might already be to late) then PAs will become an after thought..... I for one would rather quickly take a PA-->> NP bridge as they are clearly far more efficent at advocating for their own, instead of running around afraid of the AMA and other physician organizations.

 

Used to be the salary data was always released on PA week.  Not any more, way late now.  And no real ability to customize (I had great success with using the salary data in job hunting in the past, but now it is outdated the day it is released - think about it 2012 data released at the end of 2013 into 2014)  

 

I am still a member of AAPA as I feel this is the time to try and save the profession - but it would not surprise me one bit that if AAPA does not get it right we all cease to exist in  a few generations.  (and that honestly would be just dues for the AAPA repeatedly dropping the ball so many times but it will hurt every single one of us that actually care for our patients and work in the "trenches")

 

 

AAPA is heading the way of the AMA as it only has a tiny % of doc's as members and AAPA will soon mirror that if they do not pay attention.

[Guest Paula]

Paula, that is an action-packed post! :) I do agree with a few things you said, particularly the need to enhance the public image of PAs, and to move from "supervising" to something like the VA did, which is "collaborative." I applaud your committment to enhanced utilization as reflected by your involvement in PAFT. But I don't understand why you think AAPA, or really the PAs who the AAPA represents, should not care about social causes of poor health. If poverty causes poor health, then we should fight poverty. If the evidence says that X causes disease, morbidity and mortality, then I've never understood how a PA, or any medical practitioner, can just pick and choose which evidence we embrace. I don't see how we can say, "OK, I will follow the evidence that says smoking kills people and work to have my patients stop smoking, but I will ignore the evidence that says that LBGT patients are not treated equally, that says that education about guns and violence reduces morbidity and mortality. I just don't see how we can say "I reject that evidence, but I embrace that evidence." 

I'm not sure where you got the idea that I am against treating medical issues related to poverty, smoking, LGBT issues, etc.  What I was saying that there are policy or position statements in the archives that have said that a PA should not be involved in administering the lethal injection in the death penalty, but could care for the body afterwards.  Then it supports PAs who are involved in administering abortions.  So it is unethical to give a lethal injection of a convicted criminal but ethical to take the life of an unborn child?  Does not make sense.  Or if I have a patient coming in who states he is gay I cannot talk to him about gender confusion and give him guidance that he may not really be gay, is  having same sex attractions as a part of adolescent angst?  Policy/position statements have said that is grounds for discipline. So I can't support AAPA for these kinds of positions.

I care for patients of all sizes, stripes, sexual orientation, ages, gender, indigent, rich, etc.  I was just answering your question....hope this clarifies. 

[Jim Anderson]

But Paula, these are policies that are determined by members, not by "the AAPA." That's why membership is so important, because we can shape what it means to be a PA, and what our org stands for. And BTW, there is not any policy about conversion therapy that dictates discipline. That is just not true. The role of policy is to tell the world what PA think, not to punish PAs. The conversion therapy policy does not preclude you from having those conversations, it simply says that being gay is not an illness. Would you not agree with that?

[EMEDPA]

as an aside I believe this forum now has more active members( > 34,000) than the aapa has members....

• 155,274 Total Posts
• 34,445 Total Members

[burnpac]

...What I was saying that there are policy or position statements in the archives that have said that a PA should not be involved in administering the lethal injection in the death penalty, but could care for the body afterwards. Then it supports PAs who are involved in administering abortions. So it is unethical to give a lethal injection of a convicted criminal but ethical to take the life of an unborn child? Does not make sense....

Paula - you are right. It doesn't make sense. I believe your angst on reproductive issues is misplaced, and a misinterpretation of the formal AAPA's policies on reproductive health, which are found in section 4600.6 of the PM. The word abortion appears in only one place in AAPA Policy, and that is in the Guidelines for Ethical Conduct for the PA Profession:

 

"Patients have a right to access the full range of reproductive health care services, including fertility treatments, contraception, sterilization, and abortion. Physician assistants have an ethical obligation to provide balanced and unbiased clinical information about reproductive health care."

 

All of these policies are patient centered, not PA centered.

 

 

Sent from my iPad using Tapatalk

[SocialMedicine]

I would like to see the AAPA comment on the number and quality of educational institutions. Be an advocate for current PAs and ensure we are not saturated with low quality clinicians. I just went online to look at a program near my office. Not affiliated with a medical school, faculty members seem different then a year ago and none seem experienced or very academic, 50% pass rate on boards. Total joke. And the university is laughing it up as it collects 50K a student in tuition. They will let this joke run a few years and cash out when the profession sinks.

[HLReed]

Jim, you really threw yourself to the wolves here, man.

 

 

...we need magazine ads, late night radio ads, etc....

 

All due respect to your career accomplishments, this is an absurd idea for the distribution of pro-PA funds and highlights a flawed attitude toward the advancement of our profession. That is perhaps the most expensive avenue of communication possible and really only increases our visibility to the general public. The general public are not the ones stonewalling our progress. The only thing that will sink the profession is laws being passed that impede our professional utility. Money needs to be spent towards advocacy on the national and state legislative level.

 

No general "PAs-Are-Awesome" late-night radio ad or TV commercial is going to invigorate the public to advocate to lawmakers on our behalf. Thats a poor use of funds and really reflects more of a desire to be admired at cocktail parties than to grow as a profession that will shape the future of healthcare. I don't see or hear any ads from "Nurse Practitioners for Tomorrow" on the TV or radio. But that profession is steamrolling ahead.

 

I don't disagree with everything you've ever said, but I'm a bit disappointed in the talking points that are repeatedly hammered on this forum. I think the first step in leadership is checking ego and personal desires at the door.

 

 

(Not to mention, even if you did want to launch a big-time information campaign, radio and magazines? It's 2014, that is not the way efficient marketing campaigns are run.)

[EMEDPA]

the NPs have a huge marketing budget. they even have organizations like Johnson and Johnson placing ads for them. they have organizations like the institute of medicine and the rand corporation studying them and saying they need better scope of practice and autonomy. we need all this.

until the avg american knows what a pa is (and that we are not medical assistants)  we will be stuck in the role of 3rd tier assistants. we will keep getting overlooked by a congress that still thinks of us as assistants and doesn't see why assistants need to order home health care or get reimbursed for EMR use.

what we are doing now isn't working. we need to try something else. every time we win a little battle we lose several big ones.

re: marketing style: the current online approach and "one pt at a time" approach IS NOT WORKING. what do avg americans do? they watch stupid late night reality shows and read magazines in doctors waiting rooms. that's why I mention those mediums. the DOs launched a huge marketing project around a decade ago(using print, radio, and TV) and now everyone knows DO's are doctors and not holistic providers. there are many more PAs than DOs. our available marketing budget must be larger than theirs. their campaign was run by the same firm that did the "got milk?" ads with stars with milk mustaches.

[EMEDPA]

 

"I don't see or hear any ads from "Nurse Practitioners for Tomorrow" on the TV or radio. But that profession is steamrolling ahead."

 

that's because they have an effective national organization that fights aggressively for them and actively goes after anyone who says they are not quality providers of medical services. They fund studies to show they deliver quality care and then make sure everyone hears abut them, they don't need an NPs for tomorrow....they are already at tomorrow while we are still in 1970.....

[GetMeOuttaThisMess]

^^^. Amen. I have to say that if I were starting out today, I would have taken a separate pathway knowing what I know now. There wasn't the track record then that there is now.