State Bill to Expand PAs' Scope Pulled After AAFP Warning

[ProSpectre]

I think this has been mentioned elsewhere, but this is the first news release I've seen about it. I'm curious to hear comments from PAs about how we can prevent these roadblocks in the future. The AAFP worked to block the bill due to the "grave danger" PAs would pose to patients if it went through. 

https://www.aafp.org/news/government-medicine/20180326dmsscope.html 

[sas5814]

It is difficult because what you are pushing against is the opinions of the "experts". For many years here in Texas physicians have been claiming doom and death for every advance we have made. There is never any proof because there is none. 

It takes planning and coordination and, when possible, cooperation with other stakeholders.When the physicians are just dead set against something we have to have facts and challenge them to do the same. I have testified in committee in Texas and, when I got to go first, would say very clearly....others are going to come in and make claims of danger and risk to patients. I respectfully request you ask them for evidence or measurable proof...they will have none because there is none.

 

Sometimes it works ...sometimes it doesn't. It's politics after all and money and votes often come in first ahead of truth, right, and wrong.

[ventana]

It has been kicked around for years

 

But I really think at some point a "restraint of trade" lawsuit is the way to get change on a nationwide way......

 

would not be easy, and AAPA and NCCPA would never undertake it due to the political nature, but some crazy rich PA that pushed it might just get it!!

[ProSpectre]

Yea i'm not terribly surprised the above bill was opposed by physician organizations considering the language about creating a new doctorate trained medical practitioner with expanded scope of practice and collaboration rather than supervision. 

However, I think the way it was strongly opposed and quickly shelved does not bode well for states who will be introducing bills for OTP in the (hopefully near) future, so maybe this can be used as a learning tool in how to approach things going forward. 

[sas5814]

I think OTP efforts will meet mixed reactions and there is something to learn from the failures as well as the successes...and the successes will come. It is just going to be a long process.

[Gordon, PA-C]

This article was poorly written.

It doesn't even describe what the new Tennessee law would do.  Does it give only DMS holders autonomy?  Do they still have to get a "collaborating" physician?  

What exactly was the Tennessee bill supposed to do?

[ProSpectre]

3 hours ago, Gordon, PA-C said:

This article was poorly written.

It doesn't even describe what the new Tennessee law would do.  Does it give only DMS holders autonomy?  Do they still have to get a "collaborating" physician?  

What exactly was the Tennessee bill supposed to do?

Well this article was released by the AAFP, the same organization that blocked the bill. 

Here is a quote from the summary of the bill (link to the full summary is in the article):

"This bill requires that new healthcare practitioners function only in collaboration with patient care teams. A new healthcare practitioner will be authorized to perform those tasks that are within the new healthcare practitioner's range of skills and competence and that are consistent with the protection of the health and well-being of the patients, as determined by the board. This bill authorizes a new healthcare practitioner to render emergency medical service outside the usual scope of practice previously established by the board in cases where immediate diagnosis and treatment are necessary to avoid disability or death."

And a link to the bill itself: http://www.capitol.tn.gov/Bills/110/Bill/HB2122.pdf

[SedRate]

So their answer is that individuals who are not physicians and have limited oversight provide care that's less-than. I'm assuming this is also a state that doesn't have independence for NPs... 

And their answer to the lack of primary care is not to increase practice rights of PAs but to get the government to provide more funding, relieve student debt, and increase training?

Interesting.

[DankPA]

Is it so wrong to ask for more independence in today's current lack of primary care medical professionals even though we technically have less training than physicians do? I don't think so. From what I've seen so far, physicians just unload their work onto us and get all benefits. If I am doing their jobs, is it wrong to ask for an expansion of my scope of practice? 

[narcan]

There were a lot of legitimate problems with that bill, not the least of which is that it was written and sponsored by LMU, who wanted it passed so they could attract students to their DMS program. It was all about money.

[ProSpectre]

On 4/4/2018 at 2:52 AM, narcan said:

There were a lot of legitimate problems with that bill, not the least of which is that it was written and sponsored by LMU, who wanted it passed so they could attract students to their DMS program. It was all about money.

I don't disagree with that. The reason I posted this is because I think it can be used as a case study going forward for the arguments some physician groups may make against OTP when state-level legislation is introduced. Obviously OTP is a whole different animal than this bill, but it will be important to be careful in how it is framed and the language used when introducing legislation on the matter to prevent outright opposition from certain physician groups. Some of the quotes in the article from physicians in opposition to this bill would likely be applied to any future OTP legislation that is introduced as well. 

[narcan]

I wrote that on the fly, I hope it didn't come out against the point you're trying to make, which is I don't doubt accurate with regard to how the AAFP and other physician groups will likely oppose OTP. Interestingly enough, there's a similar bill being floated in Virginia, and a similar DMS program that just started at Lynchburg College.

Whether by design or compromise, the wording is such that it retains an agreement with an SP and isn't too far from OTP.

SB 505

"The bill provides that doctorates of medical science can practice only as part of a patient care team at a hospital or group medical practice engaged in primary care and are required to maintain appropriate collapboration and consultation, as evidenced in a written or electronic practice agreement, with at least one patient care team physician."

Of note, the governor just signed HB 793, which gives nurse practitioners full practice authority. Let the games begin.

[vb315]

On 4/7/2018 at 2:11 PM, narcan said:

Of note, the governor just signed HB 793, which gives nurse practitioners full practice authority. Let the games begin.

Just read through the bill, and it gives NPs full-practice authoirty after 5 years of clinical practice. It mentions that the NP may practice "...in the practice category in which he is certified and licensed..." I don't understand how it's so easy for NPs to push this. I'm naive and don't know much about the process of proposing/changing laws...but NPs are doing so across the board, and easily. I just don't understand why we (PAs) can't.

For those with more understanding, what's the biggest hurdle, what's stopping us?

[ProSpectre]

11 minutes ago, vb315 said:

Just read through the bill, and it gives NPs full-practice authoirty after 5 years of clinical practice. It mentions that the NP may practice "...in the practice category in which he is certified and licensed..." I don't understand how it's so easy for NPs to push this. I'm naive and don't know much about the process of proposing/changing laws...but NPs are doing so across the board, and easily. I just don't understand why we (PAs) can't.

For those with more understanding, what's the biggest hurdle, what's stopping us?

If you've been keeping up with the posts on the Huddle, it's becoming apparent that what's holding us back may be as much from within the PA profession as those external groups who oppose OTP.  

Check out the article on page 6 of this Washington Medical Commission newsletter. The Washington Medical Commission is the 3rd largest medical board in the country, and has only 2 PAs appointed to the board, one of which penned this article.  

 https://www.doh.wa.gov/Portals/1/Documents/3000/MedicalCommissionUpdate!Spring2018.pdf 

[vb315]

17 minutes ago, ProSpectre said:

If you've been keeping up with the posts on the Huddle, it's becoming apparent that what's holding us back may be as much from within the PA profession as those external groups who oppose OTP.  

Check out the article on page 6 of this Washington Medical Commission newsletter. The Washington Medical Commission is the 3rd largest medical board in the country, and has only 2 PAs appointed to the board, one of which penned this article.  

 https://www.doh.wa.gov/Portals/1/Documents/3000/MedicalCommissionUpdate!Spring2018.pdf 

I'm actually not an AAPA member, so I'm not privy to the Huddle, but I do check the PA Forum everyday, and can kind of catch what's going on (as told by the posts here). I just can't understand the PAs that want to sit idly by as all other medical professions move into the future. I in no way support new grad PAs having independent practice, but at some point somethings gotta give. A PA practicing in Primary Care/Internal Medicine still needs their hand held after 10, 15, 20 years? I don't buy it.

I've always understood OTP as a way for PAs to be responsible for PAs (our own board for oversight, etc.), but at the same time allowing collaboration to be determined at the practice-level. The practice should know/vet their employee well enough to dictate the level of supervision they require. New-grad = the most supervision; well-established, veteran PA = the least. Having a blanket statement on supervision requirements does nothing but hurt the experienced PAs, the ones that help expand access to care that US citizens desperately need. I just don't get whats so hard to understand about that?

[corpsman89]

It's seems difficult for us young'ns to really understand why this is so difficult. 

Its obviously multifaceted. We have PAs (like James Anderson who penned that disastrous article) who use their power and position to basically fear monger and go against the hard work that AAPA has done to get OTP approved. You also have Physicians who HATE NPs but yet don't support PAs, and have basically abandoned us. 

We also have the "assistant" in our title. This, I believe, is one of our biggest set backs. Anybody who wants to put up a fight against us has the greatest argument against us: we are just assistants. It will work every time, and why shouldn't it? Who wants to be treated by an assistant? Who in the world would let an assistant run a clinic by them selves without the physician there too? Why would you ever let an assistant prescribe schedule II medications? The list goes on and on. Obviously, we know we are more than assistants, but congressmen don't, laymen don't, patients don't and THAT MATTERS. 

[vb315]

2 minutes ago, corpsman89 said:

It's seems difficult for us young'ns to really understand why this is so difficult. 

Its obviously multifaceted. We have PAs (like James Anderson who penned that disastrous article) who use their power and position to basically fear monger and go against the hard work that AAPA has done to get OTP approved. You also have Physicians who HATE NPs but yet don't support PAs, and have basically abandoned us. 

We also have the "assistant" in our title. This, I believe, is one of our biggest set backs. Anybody who wants to put up a fight against us has the greatest argument against us: we are just assistants. It will work every time, and why shouldn't it? Who wants to be treated by an assistant? Who in the world would let an assistant run a clinic by them selves without the physician there too? Why would you ever let an assistant prescribe schedule II medications? The list goes on and on. Obviously, we know we are more than assistants, but congressmen don't, laymen don't, patients don't and THAT MATTERS. 

THIS. I couldn't agree more! All that matters is how we are perceived by the public - the non-medical rule-makers. NPs have independent practice in 23 states - all because they can convince the right people to let them. We just have to change the tide, and I agree that a name change is a good move. But, this creates another issue, in that the majority has to agree on a new title *sigh*

[corpsman89]

Just now, vb315 said:

THIS. I couldn't agree more! All that matters is how we are perceived by the public - the non-medical rule-makers. NPs have independent practice in 23 states - all because they can convince the right people to let them. We just have to change the tide, and I agree that a name change is a good move. But, this creates another issue, in that the majority has to agree on a new title *sigh*

Very true indeed. But it WILL come. If David Mittman gets elected, along with James Cannon, and Beth Smolko, we should see it addressed sometime soon. 

On the other hand if David Jackson gets elected, then we wont, at least while he is in office. We may even see a drawback of OTP. 

In a perfect world we would change the title, then proceed to draft bills that would give PAs(or whatever our title is) independence after fulfilling 5-10 years of full time practice with collaboration.