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Full Practice Authority in Texas

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Why, after more than 50 years as the good right hand of the physician, should the Physician Assistant profession be thinking about full practice authority? Part of the reason has to do with the growth of the profession from a certification many years ago to a masters level program standard today (with a trend towards PhD level training). The rest of the reasons have to do with practical realities of our current health care environment and the current political trends.


Without argument Physician Assistants are now better trained and educated than ever before. Despite some fringe arguments, this does not bring us to the level of physician training. It does, however, bring us to a level where close supervision by a physician, and all the rules and regulations that accompany that, have become superfluous and now represent barriers to care while increasing the cost to provide services. Supervising” a Physician Assistant typically costs more than $12,000 annually.


The other part of the discussion, and possibly the more compelling one, has to do with keeping the profession on par with our counterparts the nurse practitioners. NPs currently have full practice authority in 22 states with legislation pending in many more. There are many many arguments about who is better trained and more skilled and that has no place in this discussion. The simple practical truth is if we, the Physician Assistants, don’t maintain regulatory parity with the NPs it will have a deleterious effect on the profession as a whole.


In Texas NPs have been unsuccessful in many attempts to achieve full practice authority. Stopping them will not last much longer and there is currently draft language supported by some Texas legislators which removes all language regarding supervision from our shared practice act for the NPs only while leaving them in place for PAs. This full-on change will not succeed but some incremental changes are highly likely. Physician influence in the Texas legislature has been on the decline for years as many legislators have figured organized medicine's positions are often based on power and control and less on what is best for patients. Their ability to stave off the NPs is at an all time low as evidenced by the many states that give NPs full practice authority. It will be like the metaphorical snowball rolling down hill and the PAs will be left behind because our state professional association actively opposes full practice authority for PAs. This is a short sighted position that will blow up in all our faces. Texas is ranked 49th or 50th nationally in delivery of health care and legislators are waking up to the idea that physicians can’t solve the problem.


If NPs achieve full practice authority they will become the overall preferred mid level”. It will become less expensive to hire and utilize them and, because they have full practice authority, then can then hire and supervise Physician Assistants. Physician Assistant salaries will decline. Job opportunities will decline. Physicians are becoming salaried employees more and more and have less and less influence over hiring and salaries. Those decisions are made by administrators and will be driven by finances and convenience. 


There is a belief among many that, by remaining the faithful servant of organized medicine, we will share their power and be their preferred mid level.  That will be true to a point but, as stated above, has become less and less relevant to the health of the profession and will continue to become less meaningful. When we no longer serve the physicians agenda they will cut us loose. At that point we will be politically adrift and far far behind the NPs. Is that really what we want to do just to avoid upsetting physician organizations? The physicians have opposed NP practice authority with all their might and yet NPs enjoy full practice authority in 22 states and are the preferred mid-level by many estimations.


This is a conversation that needs to be had and sooner rather than later. If your state legislator or your professional organization opposed FPA you deserve to know why and the answer should be based on what is best for patients first and what is best for the PA profession second regardless of what 3rd parties might not be happy with us. After all the NPs have been the mortal enemy of organized medicine for many years and they have FPA in 22 states and counting. Discuss it with your legislators. Most certainly discuss it with your representative organizations. If none of them are serving your interests it may be time to fine someone else to represent your needs. Also discuss it with your peers. The more informed opinions there are the better the outcome.


If you haven't read the AAPA survey on the matter please do. I found it very informative. It can be found here.  

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A quick follow up... this is a post from another forum about a PA experience. While generally this is rare it may become common if we don't pay attention:


I just went through an entire credentialing process with a locums company for a hospital in Texas that lost all their providers due to a contract change with a new hospitalist service.  The locum company was given the contract to staff the hospital and credentialed numerous PAs and NPs.  I was to start this week and I just received a call last night that PAs are not welcome. The hospital "misinformed" the staffing company and they want NPs only.  No explanation given.

This is in Texas where there is not a reason for this hospital system to deny PAs work opportunities.  

I hope we all take notice of this in a state where there shouldn't be any regulatory difference, just a company/hospital that has denied PAs work based on their credential.  

I have asked for some explanation why me and three other PAs were denied work.  I suspect I will not be receiving a call.  I also wrote the Texas academy yesterday and not response yet.

Do not think for a second that the NP agenda will not succeed in Texas and many other states.  I have no animosity against them, but our ability to earn and work is being threatened.

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  • 3 months later...

I did get a response from TAPA on this matter via the Huddle.  At that time they stated they were waiting on the AAPA to decide and that they would state their position after.  Well AAPA has decided and we still have yet to hear from them.  We also have a state association that tried to bargain putting anesthesia assistants on our practice act in order to gain support for other en-devours they were working towards.  It is true that in Texas things are becoming very pro NP.  While PA's are not permitted to own a majority share of a healthcare practice, a NP has no problem with it.  According to TAPA it is because they put limits on PAs, but seemed to forget about NPs.  As long as an NP has a RN license then she can technically own the company do "monitor the public health."  Our state organization has said it is a definite gray area, but said that NPs are breaking the law.  I invited them to tour the Texas panhandle, to see these NP owned practices but have heard nothing.  

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