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Military and Optimal Team Practice


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Optimal team practice (OTP) is a big deal these days.  It has been since last May when AAPA made it the official policy. 

There is a reticence to accept OTP at the state level.  I was in a recent discussion with a fellow PA (and board member of PAs for Tomorrow) who is a military retiree.  As we discussed the benefits of OTP, we both expressed concern that it wasn't already the "norm."   We discussed OTP and the military and realized that those of us in military medicine have practiced OTP for quite some time.

Take a quick look at the four pillars of OTP

  • Emphasize PAs’ commitment to team practice;
  • Authorize PAs to practice without an agreement with a specific physician—enabling practice-level decisions about collaboration;
  • Create separate majority-PA boards to regulate PAs, or give that authority to healing arts or medical boards that have as members both PAs and physicians who practice with PAs; and
  • Authorize PAs to be directly reimbursed by all public and private insurers.

All members of military healthcare, whether PAs, Nurses, NPs, or technicians are committed to team practice. 

Even as a "personal service contractor" I practice under the same Air Force Instructions (in particular AFI 44-119) as active duty and civil service PAs.  The AFI reads, "PAs are health professionals whose practice is centered on patient care and disease prevention and may include clinical teaching, patient education, research, and administrative activities. PAs are certified to practice independently and collaboratively in providing primary healthcare.(emphasis mine)." 

The military does not include boards to regulate PAs.  At least with the AF, the credentials committee members are intimately familiar with PAs, and when a PA is up for privileges, a PA sits on the committee. In a former life, I actually chaired the committee as a PA and deputy chief of the medical staff.

Reimbursement is not an issue for military providers.

All of us eventually leave the military.  Most continue to practice as a PA.  Outside of the military, we come under a different set of rules and laws--and a change in HOW we practice.  If you know where your retirement location will be, consider having the best practice opportunity available to you--work with your future (or current) state to make OTP a reality.

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8 minutes ago, pafrankc said:

Optimal team practice (OTP) is a big deal these days.  It has been since last May when AAPA made it the official policy. 

There is a reticence to accept OTP at the state level.  I was in a recent discussion with a fellow PA (and board member of PAs for Tomorrow) who is a military retiree.  As we discussed the benefits of OTP, we both expressed concern that it wasn't already the "norm."   We discussed OTP and the military and realized that those of us in military medicine have practiced OTP for quite some time.

Take a quick look at the four pillars of OTP

  • Emphasize PAs’ commitment to team practice;
  • Authorize PAs to practice without an agreement with a specific physician—enabling practice-level decisions about collaboration;
  • Create separate majority-PA boards to regulate PAs, or give that authority to healing arts or medical boards that have as members both PAs and physicians who practice with PAs; and
  • Authorize PAs to be directly reimbursed by all public and private insurers.

All members of military healthcare, whether PAs, Nurses, NPs, or technicians are committed to team practice. 

Even as a "personal service contractor" I practice under the same Air Force Instructions (in particular AFI 44-119) as active duty and civil service PAs.  The AFI reads, "PAs are health professionals whose practice is centered on patient care and disease prevention and may include clinical teaching, patient education, research, and administrative activities. PAs are certified to practice independently and collaboratively in providing primary healthcare.(emphasis mine)." 

The military does not include boards to regulate PAs.  At least with the AF, the credentials committee members are intimately familiar with PAs, and when a PA is up for privileges, a PA sits on the committee. In a former life, I actually chaired the committee as a PA and deputy chief of the medical staff.

Reimbursement is not an issue for military providers.

All of us eventually leave the military.  Most continue to practice as a PA.  Outside of the military, we come under a different set of rules and laws--and a change in HOW we practice.  If you know where your retirement location will be, consider having the best practice opportunity available to you--work with your future (or current) state to make OTP a reality.

It has been a somewhat difficult transition for me going from being pretty much treated like a physician to having all these new restrictions. The fact that I expected it to be worse than it is by being a resident has helped, but it still have to catch myself before slipping into old habits.

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6 hours ago, LT_Oneal_PAC said:

It has been a somewhat difficult transition for me going from being pretty much treated like a physician to having all these new restrictions. The fact that I expected it to be worse than it is by being a resident has helped, but it still have to catch myself before slipping into old habits.

I retired in 04.  First job was locums as VA, quite a bit of autonomy--VA Clinic Gallup only had two providers.  Next was in UK--part of pilot program so we brought OTP in without calling it that (our training in some ways exceeds the GP over there.

4 years civilian practice.  Both PAs were retired military given quite a bit of freedom.  They hired a 3rd PA, non military trained, but she was worthless--couldn't keep up.  Since then been with military medicine.

I plan on retiring from clinical practice this summer, but will continue to be a thorn in Colorado's side as I push for OTP.  

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30 minutes ago, pafrankc said:

I retired in 04.  First job was locums as VA, quite a bit of autonomy--VA Clinic Gallup only had two providers.  Next was in UK--part of pilot program so we brought OTP in without calling it that (our training in some ways exceeds the GP over there.

4 years civilian practice.  Both PAs were retired military given quite a bit of freedom.  They hired a 3rd PA, non military trained, but she was worthless--couldn't keep up.  Since then been with military medicine.

I plan on retiring from clinical practice this summer, but will continue to be a thorn in Colorado's side as I push for OTP.  

You get it there and it’ll be the first place I move after residency!

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4 minutes ago, LT_Oneal_PAC said:

You get it there and it’ll be the first place I move after residency!

MI is looking pretty good right now. Also seriously consider applying to the pa owned em group in VT if you can see yourself in that part of the world. I would be there now if I could talk my wife into moving...

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