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PAFT statement on PAs and primary care

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PAs and the

                         Provision of Primary Care

The PA profession has demonstrated that it can provide high quality primary care to patients. The demand for primary care practitioners continues to escalate as the number of physicians entering primary care specialties continues to decrease. Attempts by medical schools to bolster primary care ranks have been largely unsuccessful.  Most entering medical students who list primary care as their probable residency choice ultimately choose a specialty residency.

PAs for Tomorrow (PAFT) believes that PAs are a logical answer to America’s primary care crisis. PAFT also believes that the opportunities for PAs as primary care providers are vast and immediately accessible.  The PA community has the possibility to broadly define the future in this specialty.  A progressive focus and defined framework will facilitate efforts to expand the presence of PAs as primary care providers.

PAFT believes the PA profession will succeed in insuring a successful future in primary care if we advocate for:

Practice Autonomy

PAs are members of a team. The practice of medicine is complex and requires creative utilization of all skill sets.  PAs in primary care will require autonomous practice within that team framework to be fully successful.  PAFT believes that present day supervision requirements are a significant barrier to many PAs who would otherwise practice primary care in underserved regions.  PAFT further believes that when fewer physicians practice in a given specialty and geographic location, PAs will also be fewer in number as a direct result of antiquated supervision requirements. Supervision language in PA practice legislation is not conducive to autonomous practice, deterring well-trained PAs from primary care. Removal of supervision barriers to PA practice is critical to long term successful utilization of PAs in this setting.  Legislation conceived and enacted when the profession was unproven remains despite evolution and maturity of the profession.  Language and laws that accurately reflect present day PA practice must also evolve.  Legislative reform allowing PAs full practice autonomy is imperative for PAs to practice at the top of their license and education.


PA training produces a capable, qualified health care provider that is well suited for primary care practice.  Uniform, standardized PA training as generalists offers exposure in all medical specialties. PAFT believes PAs who desire to practice with full autonomy would best succeed by completing residency training.  Alternatively, PAs who spend a minimum of two years in family practice/primary care specialty under the tutelage of seasoned primary care providers will then be better prepared for autonomous practice as compared to a new PA graduate.  In the interest of expanding training opportunities, the AAPA should seek federal funding to develop at least one PA primary care residency program in each state in the US.

Delivery Design and Practice Ownership Equity

Identifying alternative ways of bringing quality primary care providers to underserved populations could be accomplished in a number of ways.  One consideration could be an expanded retail clinic concept that allows PA ownership. Federal loan opportunities would ease start up expense and bolster success for both independent and group practices.  Practice ownership barriers for PAs should be eliminated in all states.  PA equity and partnership will only foster clinician retention.  PAs who have interest in or own a practice are more likely to remain vested long term.  Further, PAFT believes that PAs should seek leadership roles in emerging primary care delivery systems including telemedicine care, home call services, PCP oriented urgent care and others.  PAs are well suited and well trained to function in any of these capacities. 


Tuition Reimbursement

PA education is expensive. It has been anecdotally noted that high student loan debt deters many providers of all types from pursuing careers in family practice.  PAFT believes that aggressive lobbying for loan repayment for any PA choosing qualified primary care practice is a viable solution. PAFT envisions repayment beginning after one year of practice.  Repayment then continues for a period of three more years.  To be free of educational debt, a PA would be required to maintain primary care practice for a period of no less than four years. 


Reimbursement Equity

Payment policies reimbursing PAs less than physicians for equivalent care hinders PA practice in primary care.  Medicare, Medicaid, and private insurers typically reimburse PAs 85% or less than physicians for the same services.  As a result, billing practices to capture 100% reimbursement is often the norm, “hiding” a PA’s financial contribution to a given practice.  Additionally, primary care services tend to be undervalued compared to specialty providers of same or similar services, further lowering reimbursement.  PAFT believes reimbursement inequity and devaluation of care must be eliminated.  .   


Organized Medicine

PAFT believes in a committed, comprehensive campaign to educate physicians, administrators and policy makers of the PA profession’s utility as an immediate workforce of healthcare providers.  This is critical for the successful promotion and utilization of PAs in this capacity.  PAs are qualified and accessible but are hindered by constraints in both policy and legislation at multiple levels.  PAFT believes that the PA profession should aggressively and progressively seek change in policy and legislation.  The individual PA’s future and security are directly linked to the collective profession’s growth and evolution. The changes PAs seek are not to divide or separate from the healthcare team.  To the contrary, these changes facilitate inter-professional collaboration, strengthen the medical team, foster innovative practice, and enhance accessibility of high-quality primary care. Further, these advancements will also give us equity with other professions, which is critical if PAs are to be viewed by organized medicine as a viable resource.


Commitment to Further Research

PAs provide primary care well – at least as well as our primary care counterparts.  PAFT maintains that PAs as primary care providers of longitudinal healthcare exceeds the effectiveness of delivery platforms that offer more disrupted access to care. The only true measure to confirm that hypothesis is research.  PAFT contends all delivery platforms of primary care services by all health care providers should be studied and documented.  PAs leading patient centered medical homes should be measured to confirm that PA outcomes are equivalent to or better than other providers of the same services.  Cost savings and quality of care should be accurately researched by provider type.  The contribution of PAs to the US healthcare system has been neglected by organized medicine as well as the PA profession.  It’s time that contribution be accurately documented to support the utilization of PAs in the delivery of cost effective, high quality primary care services. 


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Thanks for posting that E, while I agree with the above statement I have to wonder if PAFT will release a similar statement in regard to the other specialties?... EM....IM....surgery. etc.... PAFT seems to purport itself as representing all PAs, no? If that is the case Will/does PAFT have a similar statement in regard to other specialties?


If PAFT choses to focus on primary care, well that's ok too. I just think they should make that very clear in their statement so PAs can have accurate information prior to committing their funds.


I don't mean ill will, and I'm most certainly not trying to start a "fight". It just seems the above statement represents PAFTs goals/beliefs, which seem to be primary care. . If not, why would

they not include other specialties in their(the above statement) statement? I have long thought PAFT is working in the right direction, however given the above statement I am reluctant to give my support.  


I look foreword to any response by PAFT, or their reprehensive.    


EDIT: by "reluctant to give my support" I'm an ED PA and while I support all Pa specialties, there is only so much money to go around. So I will financially support those groups who specifically support EM PA's first.     

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PAFT has put out position statements on Full Practice Responsibility and The Highest Level of Care.  Both include the statements that PAs should be able to practice to the top of their license and be responsible for their own practice and the care that they provide to patients.  This is for all PAs, not just those in primary care. Please re-read them.  You will find them on the PAFT website. 


The above statement is more specific since PAs are not flocking to PC because of the barriers of supervision, delegation and the trend of hiring other advanced clinicians instead of PAs in rural and underserved areas.  Plus the takeover of PC by other professions similar to ours and the aggressive campaigning by the other profession to be seen as the choice for PC seems to be diminishing our opportunities in PC. 


The PA profession has long been touted as the answer to meeting the needs of patients who have decreased access to care simply because of their location of residence.  So, we have two choices.......


#1. Complete practice authority for PAs in PC so we can regain our original place as PC providers.  It will not happen if we remain legally tied to physicians in order to practice and in order to be hired in PC.  Physicians are not flocking to PC either.  


#2.   The second choice is if we cannot achieve full practice authority is to overhaul the focus of PA education and stop telling PA students that we are poised to provide primary care for the nations needy patients.  Then we will have PAs that continue to follow physicians wherever they go and it will dictate to a point of where PAs practice and in what setting.  IMHO.


PAFT still believes all PAs should have full practice authority in all settings and are working for all of us and in all specialties. 


Keep us honest, Evolute and we appreciate your feedback.  We want to always listen to our members.  Keep tuned, we are not done yet. 


Eric can chime in here if I am misspeaking about PAFT's goals and focus.  




Director at Large, PAFT. 

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Paula, thank you for your reply, It is very refreshing to hear from a leader directly,  and not get a form letter that starts with "dear sir or madam". That alone speaks volumes.


My post to the OP was not in angst or anger, but to question, and you answered said question(s) with grace and intelligence. To your request, I have been reviewing the PAFT web site over the past several months and am acquainted with the stated policies/procedures/statements. hence my question. 


Joeleff, I'm not sure what you are trying to say with your picture above( maybe trying to start seizures?), I will give you the same advise I give to my kids...... Use your words...... use your words...... you know them.... you can use them ........

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Paula, thank you for your reply, It is very refreshing to hear from a leader directly, and not get a form letter that starts with "dear sir or madam". That alone speaks volumes.


My post to the OP was not in angst or anger, but to question, and you answered said question(s) with grace and intelligence. To your request, I have been reviewing the PAFT web site over the past several months and am acquainted with the stated policies/procedures/statements. hence my question.


Joeleff, I'm not sure what you are trying to say with your picture above( maybe trying to start seizures?), I will give you the same advise I give to my kids...... Use your words...... use your words...... you know them.... you can use them ........

It's called an applause... Usually done when cheering on someone or something. In this case I am applauding the PAFT statement..... >_>


Sent from my S5 Active...Like you care...


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thanks for your reply joelseff, for the record I knew what you were "saying"..... I just couldn't resist.  


For full disclosure my youngest is 14, so I haven't used the words "use your words" for some time. Just Prior logging in I spent 4-5 hours with my in-laws..... listening to them saying "use your words" ...."use your words" He's 2 years old for f#$ks sake....give the kid a break!.....F@#k me.... really?


anyway, joelseff, I apologize if I offended, can we still be friends? 

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LOL - I have a 3 month old ... and a two year old.  I don't have to remind him to 'use your words' often, it's more to 'use your manners' (please, thank you, etc.)!  That being said, I also have a 23 and 25 year old and I seem to recall some variation on 'use your words' when they were teenagers ... because I don't respond to grunts or blank stares!  

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Thank you all for this discussion. I joined PAFT just before the DC AAPA conference and had been wondering about its apparent focus on primary care from things like PAFT emails reminding me of family practice conferences and the position paper above. I agree that primary care will be lost to PAs without the same level of autonomy that NPs are getting and commend PAFT for getting involved. 


As a practitioner in a specialty, I agree with the need to press forward beyond primary care as well.


With any luck, it could be a brave new world. Thanks for all of you who are taking an active role in this.

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Paula, Is there anyway that PAFT might expand their position paper to include the autonony for specialities? My view is why not tackle it all at once? Save yourself an advocacy trip. Also, I'm guessing that many PAFT members work in specialties.


Sent from my SM-G925P using Tapatalk


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I'll bring it up for discussion at our next board meeting or in September when I am at NOLA at the AFPPA conference.  BTW:  PAFT will have a meet and greet time for any interested people who are attending the conference.


I don't know the time yet or exact location where we will be so look for us and listen for announcements. 

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