Texas Medical Board Proposed rules change

[fireguy]

just received this from the Texas Academy of Physician Assistants.  WTF?

 

Quote

PLEASE READ AND RESPOND TAPA wants the members to be aware of proposed rules by the Texas Medical Board, as published in the Texas Register on January 25, 2019.  The proposed rules are found on this website, under the hyperlink "Proposed Rules": https://www.sos.state.tx.us/texreg/pdf/currview/index.shtml In short, Section 193.21(d) states that there are certain acts that cannot be delegated to a "mid-level provider" (their words): "The reading and interpreting of radiological studies, and rendering a diagnosis based upon radiological studies".   TAPA is very concerned about the implications of this language and the possible detriment to the practice of all Texas PAs and ultimately the patients. PAs have ordered, read, interpreted and rendered treatment to patients based upon radiological studies for years, in accordance with practice agreements with physicians.   TAPA is currently crafting a response to the Texas Medical Board and will continue to pursue this issue.   The Texas Medical Board is currently soliciting public comment on these proposed rules and have provided an email address for contact.  We encourage our membership to express concerns regarding these rules and to solicit a response from your collaborating physicians at the following address, as provided by the Texas Medical Board: rules.development@tmb.state.tx.us.  You can also send a formal letter to the following address: Texas Medical Board ATTN: Rita Chapin PO Box 2018 Austin, TX 78768-2018 Please copy your response to TAPA Board of Directors. These responses will be helpful in our testimony to the Texas Medical Board. Email here: tapatxinfo@gmail.com Thank you to members who have contacted us; please know that we are working diligently on this issue and will provide more information as it becomes available. TAPA Board of Directors

 

[Rondaben]

This was a proposal that was announced on Jan 25th.  The proposed language was not passed through the Texas PA Board or the Nursing Board.  It was essentially out of the blue.  The language clearly contradicts that of the PA practice legislation in the Occupations Code 204.202.   In essence, the rule would prevent PAs and NPs from interpreting radiology studies or making a diagnosis based on radiological studies.  

Right now the best way to fight this is to inform physicians and PAs of the effects this rule would have on our profession and on public health.  

[lemurcatta]

This is why independent PA boards and getting rid of delegated service agreements are important. 

[Rondaben]

Another thing is that the attempt in this rule is to reclassify job tasks that have historically been within the purview of our scope as now requiring "independent medical desicionmaking".   If this were to occur in a state that had legislatively granted independent practice to NPs it would only affect PAs.   Makes you think.

[NeoTrion]

It would definitely be helpful if PAFT would get involved with this.  The more pressure the TMB feels than the better.  Since this would also affect NPs it would be helpful to get them in the loop as well.  I think TAPA is also reaching out to AAPA for help.  We really need to get Texas PA's and our special interest groups on this one.

[Cideous]

So here is the thing.  I've been practicing in this state for 25 years.  If this gets passed as written, it will end us here.  The ability to order, interpret and diagnose based on imaging has been a no brainer delegation since I took my first job.  To strip that away now is inconceivable.  When will this *rule* be voted on?

[jmj11]

Is this a "solution" in search of a problem? In other words, did something happen to trigger this response? I bet not, that it is purely political. While many preliminary reads are done by the PA or MD in the acute setting, I don't know any situation, correct me if I am wrong, where the final read is not done by a board certified radiologist. 

[GetMeOuttaThisMess]

3 minutes ago, jmj11 said:

Is this a "solution" in search of a problem? In other words, did something happen to trigger this response? I bet not, that it is purely political. While many preliminary reads are done by the PA or MD in the acute setting, I don't know any situation, correct me if I am wrong, where the final read is not done by a board certified radiologist. 

Unless done in office such as in a specialty setting.  Back in the 80's we'd read our own in house spine films.  CT's (pre MRI days) were read by radiologists since they were done outside.

[sas5814]

There is a core problem that is the genesis of this and other issues previously such as practice ownership and anesthesia assistants. The Texas Medical Board is a branch office of the Texas Medical Association. TMA is not and never has been a friend of the profession. They are probably one of the most old school backwards boards in the country. I could make a strong argument they are an active nay proactive enemy of the profession. This is evidenced by many "rules" they pass and try to pass "in the interest of patient safety" that really just protects power and money of the physicians. Yet we continuously hear about maintaining our "relationship" with organized medicine.
When TAPA finally has the common sense to realize they are actively working against us and stop worry about what is a dysfunctional parent-step child relationship we can get down to some bare knuckles work. It will be difficult and will take years but at least we will be working under conditions that reflect reality.
We need OTP. We need our own board. Then none of these problems will be forced on us and we will be positioned to advance the profession.

[Cideous]

^^^^

This is 100% correct.  It has always been this way in Texas.  

 

If this passes I will be out of a job.  A provider who can not order and interpret X-Rays in Urgent Care is not a provider who will be working.

 

 

 

Anyone know when this will be voted on?

[fireguy]

not sure how I will continue working ER either, especially when I work solo in west texas or the panhandle. 

[Kaepora]

How would literally any APP work in UC, ER, any hospital setting, etc.  I really hope this doesn't pass.  Even though you may not be in Texas, a regressive ruling such as this would endanger our practice in every state.

[sas5814]

I gotta tell ya.... I'm getting tired of being victimized by organized medicine. I keep kicking TAPA around because they are an easy target but it really just comes back around to the physicians. We HAVE to get loose from supervision and get our own board.

[medic1210]

RE: the particular implications of this rule change in a more universal sense, should future PAs be concerned about pursuing a potential three figure debt inducing degree?

 

How successful has the PA community been with preventing these types of regressive legislation in the past? Any examples?

[NeoTrion]

SAS it is good to see that you decided to take the bull by the horns and give some new leadership to our state org.  I would like to echo to every Texas PA on this board to send in your opinion ASAP.  Legislatively TAPA is working on this, but we need stated opinions behind us.  Some feel that this may have been a swipe at OTP or NP OTP in the future.  

[sas5814]

Just so. It takes everyone doing what they can to advance the issue. TAPA can be the spokesgroup but we need a force of numbers writing, calling, and just helping in whatever manner their times and circumstances allow.

[Cideous]

We might want to think seriously about joining forces with NP's in Texas to stop this.  They seem to be much better at getting stuff done.  An organized front is the only way to a successful defense.  Honestly, this goes for most issues now confronting all Advanced providers.  If we need to ride on the coat tails of NP's then so be it.  Our own leadership has been impotent for 30 years on issues such as name change and OTP, so if it takes sending a check to the Nurse Practitioner lobby, maybe i'll consider it.  Frustrating.

[sas5814]

It appears TMA is opposed to this as well so I'm not sure where it came from. Having them oppose this gives it a much better chance of being defeated.

[ArmyVetDude]

1 hour ago, sas5814 said:

It appears TMA is opposed to this as well so I'm not sure where it came from. Having them oppose this gives it a much better chance of being defeated.

You guys need to join forces with NP. They are getting things done 

[Kaepora]

Honestly, I wish NPs and PAs would just team up.  Compared to the nursing lobby and medical lobby, the PA lobby is a drop in the bucket.  The nursing lobby, I'm sure, would be happy to get some extra $$$, and the PAs would actually have a powerful backing for a change.

[Rondaben]

Here is the problem, without mincing words.

Texas PAs, to a large extent, are not involved in the future of their profession.  They do not join organizations nor do they support the actions of TAPA or AAPA to lobby for efforts in Texas.  The funds spent on lobbying by PAs and PA advocacy groups is a pittance compared to the NP lobby and TMA.

Nurse practitioners rode in on Texas PA coattails.  They are more active and, with the hope of political SuperPACS, have millions of dollars at their disposal--evident by their success for independent practice nationwide.   They are not interested in helping PAs in Texas as we are competition, and they have actively impeded our efforts in the past.

Most of the effort by TMA to pull back APPs are because they fear that their territory is being encroached upon.  This proposed rule is ridiculous in its rationale and as was previously stated, aims to correct a problem that doesn't exist.  Fear is a powerful motivator when you think that you are going to be undercut by another provider who can do the job for a fraction of the cost when you have hundreds of thousands of dollars in student loan debt.   I don't see that changing.

If Texas PAs--hell, if PAs in the entire country--want movement on being treated fairly they must do it themselves and not wait for something to be given to them.   TAPA is working on this, but the numbers show that most Texas PAs can't be bothered to stand up for themselves.

Just my opinion of course.

[Cideous]

2 hours ago, Rondaben said:

 TAPA is working on this....

 

 

How exactly is TAPA working on this?  And by exactly, I mean EXACTLY....!?

 

I sent those guys money for 20 years, yet here we are.....same name, same NO OTP.  So I ask again...what EXACTLY is TAPA doing to change our horrible name and enact OTP???

 

Thank you for your opinion.

[Rondaben]

TAPA is in contact with the parties.  They are in contact with the politicians as well about legislative efforts, but without resources lobbying against parties like the TMA and NP is not going to be terribly effective.  The legislative efforts are easily accessible on their website. 

Why is the name important at all?  It is the same name that it was 50 years ago before you decided to become a PA.  No matter what name you call yourself it doesn't define who you are.  Just the process of doing a name change and then amending the legislative language is a huge lift--even moreso in Texas where the legislature meets every 2 years.  Accomplishing this with the resources available would potentially stall efforts in other areas.
 

OTP is not something that is going to happen overnight or even in a single legislative session.  You know as well as I that whoever has the abilty to help politicians achieve their goal of re-election is going to have their ear when it comes to legislation.  The TMA and NP have the funds as well as the numbers of politically active, vocal advocates for their profession.  I understand the frustration of how slow things move here, but they ARE moving.  

 

[EMEDPA]

1 hour ago, Rondaben said:

Why is the name important at all?

 

more and more hiring decisions today are made by 22 yr old HR "professionals" who know nothing about health care. If you knew nothing at all about PAs and NPs would you not assume that a "practitioner" is a better provider than an "assistant" and an entry level doctoral degree is more impressive than an entry level MS and therefore every NP> every PA?  PAs all over  the country are losing jobs to NPs because of this. I have personally lost several jobs to NPs less qualified than I am over this.  The last AAPA survey found something like 45% of PAs personally were aware of a situation in which a PA had lost a job to an NP for reasons other than experience. Patients also do not know the difference, An HMO near me offers new patients the opportunity to panel with a PA or an NP. once again, if you did not know the difference, you would assume a doctoral-level practitioner is better than a ms level assistant.  When I was in PA school in the early 90s, the conventional wisdom was that there would be a name/title change within a decade. We will see in May what the AAPA marketing survey organization feels is an appropriate name for the profession then we must make it happen. Our name drags us down. Anyone who does not believe it needs to talk to PAs working in the trenches, not a select few specialty and surgical PAs who say "life is great , doctors love me!" The loudest voices against name/title change tend to work in very narrow fields like addiction med and specific surgical sub-specialties, where PAs are fortunate to have carved out an NP-free niche. The tide is turning at the AAPA. Progressive candidates are finally kicking out the old guard. They are going kicking and screaming and I for one and am happy to see them go. Name change and OTP will happen. A few states are already taking the lead on OTP. many states are addressing it this year.

One of my mentor's takes on this:

https://www.mdedge.com/clinicianreviews/article/72120/pa-name-game

lots of smart folks have signed on to a name change:

Physician Associate: A Change Whose Time Has Come

Final Statement of 100 PA Leaders*

June 2010

Our profession’s original name was physician associate. Physicians demanded that “associate” be changed on the grounds that it did not properly describe the desired scope of PA practice. Forty years later we have outgrown the "assistant" title. It no longer accurately represents the profession. It is inaccurate and confuses consumers. The title is misleading and carries negative connotations which we can and should avoid. As we move into a new model of healthcare delivery it is of the utmost importance that our profession’s name accurately describes our role.

We, the undersigned physician assistant leaders assert that the time to change the name of our profession has arrived. While we can debate much about a name change, we have all agreed to the below statements and thoughts. We also fully agree that the name change advocated below will advance the profession. We call on the leaders of the profession and all PAs to announce and start to implement this change as soon as possible. At a minimum poll the entire profession. We are leaders who believe it is increasingly unwise to wait longer to make this long-needed change. Collectively, the below-signed PAs have given much of their lives to the profession and are dedicated to its advancement.

Why We Need a Change

Our profession’s original name was physician associate. Physicians demanded that “associate” be changed on the grounds that it did not properly describe the desired scope of PA practice. Forty years later we have outgrown the “assistant” title. It no longer accurately represents the profession. It is inaccurate and confuses consumers. The title is misleading and carries negative connotations which we can and should avoid. As we move into a new model of healthcare delivery it is of the utmost importance that our profession’s name accurately describes our role. Why a Change Is Justified

Why a Change Is Justified

• The PA role is truly one of partnership; of association and collegiality. We work as associates and have for many years. Our profession’s birth-name in 1965 was physician associate.
• “Physicians assistant” is a generic term. It can mean anything: a person in the office that bills patients, a records assistant, the person that sets up and cleans the exam room, all the way to a certified, licensed PA. The profession must move from this generic name to one that aptly and more accurately describes our function.
• In our society, “assistant” denotes a technical job, not a profession.
• PAs are held to the same legal and medical standards as physicians.
• The title is confusing and misleading to our patients and the public in general. Since the name practically guarantees that “physician assistants” will be confused with “medical assistants”, patients are at risk of thinking they are receiving substandard care or expect that after the “assistant” a physician will also be seeing them. Most times this does not happen, nor does the physician or the PA expect it to happen. It is time to have the name mirror the reality that exists.
• The internationalization of PAs is important to the profession. Having to explain that the common meaning of the name “assistant” under-represents our true practice is a barrier, in international forums, to full understanding.
• The above problems also may keep prospective applicants and others away from becoming PAs as they would not want to go through extensive schooling only to become someone’s assistant.
• Almost all professions at the level of training of a PA (pharmacy, PT, OT, NP) are or soon will be at the doctorate level. Our education and practice is professional, as should be our title.
• “Assistant” obscures the PA’s true role in the practice. Physicians who might otherwise consider a PA do not hire one as they feel they need someone more than just another “assistant”.
• All professions should be able to name their profession. “Physician Assistant” both demeans and misrepresents our profession. It is time to claim the name that is both appropriate and our birthright and discard the one that was forced upon us.

The Process

• The profession, ideally through the AAPABoard or HOD, should immediately adopt a policy that states that “Hereafter the profession will work to be retitled “Physician Associate,” as it more accurately reflects the profession in the 21st century”.
• If the Board or House is reluctant to do this on their own, then the entire profession should be polled using the AAPA’s full database.
• This renaming can be done over a number of years, with the ability reserved to use either title in the interim if necessary, depending on state legislation, etc.
• The PA profession should advise organized medicine that this change is not an effort for independent practice but is a move to more accurately describe the scope and status of the profession and place it at a level where it belongs. It should also be explained that the name physician associate had been chosen for us by organized medicine to represent the PA profession 45 years ago. PAs should stress that after 45 years of delivering quality medical care across the entire spectrum of practice, we are choosing a more appropriate name and that we would expect nothing less than the full support of organized medicine, which will also benefit from the change.
• PA programs should include the name physician associate whenever possible—along with the title physician assistant if need be.
• “Physician Associate” allows us continued use of the initials “PA”, which are well-known to the public.
• “Associate” does not imply that PAs are equal to physicians. Associate professors are not full professors. Associate deans are not full deans. There are precedents for this.
• The profession should consider funding State-level efforts to effect this change.
• The argument that a change will open laws at the State level is a hollow one. This action can be introduced as a “cosmetic” name change amendment which will have no impact on PA practice law. If opposed, the profession can educate the legislature as to the source of the opposition, that we are asking for no increased privileges, and the current title is confusing consumers and others
• This name change should be done BEFOREthe profession embarks upon any large public relations campaign. We can effectively brand the profession through the use of the new name, avoiding any confusion of our status when compared with medical, podiatry, chiropractic and other assistants.

Therefore, we the undersigned PAs declare that because of the above reasons and more, the PA profession should adopt the name “Physician Associate” and begin an educational campaign to other medical professionals and the public regarding Physician Associates.

1. Victor H. Germino, PA.  PA Class #1, 1965-67  Duke University Medical Center PA program. One of the founders of the PA profession.
2. Robert M. Blumm, MA, PA-C, DFAAPA, Immediate past president APSPA, Past president AASPA, Immediate past presidentACC, Past president NYSSPA, Past AAPALiaison To ACS, ACC Liaison to ACS, Past Chair Surgical Congress  AAPA, Editorial Board Advance for PAs, Clinician 1, Advanced Practice Jobs, past editorial board member Physician Assistant, Clinician News, Author, National Conference Speaker, Consultant, Paragon Award Winner Physician /PA Team, John Kirklin M.D. Award for Excellence in Surgery
3. Robin Morgenstern, PA  Past AAPASecretary, Past President Illinois Academy of PAs, past Director of the PA Program of Cook County Hospital, Chicago, Past Midwest Advertising manager Clinician Reviews Journal.
4. Maryann Ramos, MPH, PA-C, Founding President NJSSPA, Secretary of the AAPAHouse of Delegates, Delegate or Alternate for many years; Current Member, Nominating Committee; Current Legislative Chair for Physician Assistants for Latino Health – Puerto Rico; Past President American Academy of Physician Assistants in Occupational Medicine; Established Liaison between occupational physicians and PAs and Affiliate PA Membership inACOEM;  Awarded the Meritorious Civilian Performance Medal, US Army Medical Corps, 2008; Past Federal Civilian PA of the Year 2002(AAPA Veteran’s Caucus); Past PA of the Year (AAPA President’s Award 1980)
5. Blaine Carmichael, MPAS, PA-C,DFAAPA, Co-Founder Association, Past president, Vice President and current Delegate at Large of Family Practice Physician Assistants, Founder Bexar County PA Society, Founder, Que Paso – What’s Happening PAs of San Antonio, Moderator of PRIMARY PA forum, Board Member, American College of Clinicians, Founding member of PA History, Texas PA of the year, 1990, has published widely and speaks at many national, state and local PA conferences
6.  Dave Mittman, PA. Past AAPA Director, Past President NY State Society of PAs, Co-Founder and creator Clinician Reviews Journal and Clinician 1. Co-Founder ACC. First PA in the USAF Reserves.  Lifetime PA Achievement Award/President’s AwardNJSSPA and NYSSPA. Co-Author of first international article regarding PA practice in America published in the BMJ. AAPA National Public Education Award Winner-1983
7.  Stephen Henry, PA-C, RNP, Co-Founder California Academy of PAs. Two times President of CAPA.  Founding member of Veterans Caucus, Founding Member Occupational Medicine Caucus AAPA. Founding Member ACC. Years in HOD, Numerous committee Chairmanships.
8. Harvey Fine, PA-C Founding President, California Academy of Physician Assistants.
9. David M. Jones, PA-C, MPAS, DFAAPA, Member, Past Governmental Affairs Council, AAPA Legislative Co-Chair for at least 10 years, Oregon Society of PAs (Chair for the 2009 session), Past President ofOSPA (twice), AAPA Co-Rural PA of the year 1988; second term as a member of the PA Committee, Oregon Medical Board
10. Roy Cary, PA-C, DFAAPA Co-founder and past president of The American Academy of Physician Assistants in Legal Medicine. Co-founder in Cary & Associates, LLC and holds a position as Senior Partner. Mr. Cary is also a member of the Physician Assistant Advisory Committee of the Nevada State Board of Medical Examiners. Retired Air Force Major.
11. James R Piotrowski, PA-C, MS , DFAAPA , Co-founder Association of Neurosurgical Physician Assistants , Past president ofANSPA , Past Vice President and board member of FAPA , Co-founder of the FAPA-PAC , Past member Florida BOM PACommittee, Past Trustee of the AAPA PACand Chairman of the AAPA-PAC , Past PA member of the council of AANS and CNS,  Past editor of the ANSPA ’s Journal.
12. Lisa D’ Andrea Lenell, PA-C, MPAS.  Internal Medicine PA, Adjunct Faculty Midwestern University, National Radio Host ReachMD XM160
13. Michael Halasy, MS, PA-C Health Policy Analyst/Researcher. Author of well known PA Blog
14.  Gary Falcetano, PA-C, Bariatric Medicine, Stockton NJ, Managing Director – Collaborative Clinical Communications,LLC. Captain (Ret.) US Army Reserve, Past Group Publisher Clinician Reviews / Emergency Medicine / Urgent Care, journals.
15.  Charles O’Leary, PA-C, Hominy Family Health Center [FQHC], 35-year practice same site; LTC [Retired] US Army/OKARNG [2 tours Afghanistan, awarded BSM/CMB]; past-OAPA Vice-President, Past OAPANewsletter Editor, 1992 Oklahoma Rural PA of Year, OU-Tulsa Medical College PA Preceptor, Past Hominy School Board President, Past Commander American Legion Post 142
16. Gerry Keenan PA-C, MMS, Emergency Medicine, AAPA Professional Practices Council, Charter member SEMPA. Charter member AFPPA. Charter member ACC.  Bar Harbor, Maine
17. Martin Morales, PA MHA. Director Physician Assistant Services, Long Island Jewish Medical Center / North Shore LIJHealth System. 
18. Stephen E. Lyons MS, PA-C,  W .Cheyenne Clinic Coordinator, Take Care 
19.  Robert Nelson, PA-C. Executive Director, Island Eye Surgicenter, LI, NY. Administrator a various surgicenters in NY metropolitan area, Author, Speaker, Director at Large-Outpatient Ophthalmic Surgery Society, Member Corporate Development Planning Committee OOSS, Consultant,   Surgical PA 30 years.
20.  Eric Holden, PA-C, MPA, EMT-P ,DFAAPA.  Practice in emergency medicine since 1987. Member of state, federal, and international disaster medical teams. Medical provider at level 1 and 2 trauma ctrs, HMOs, community E.D.s, Rural/under served E.D.s.  Provides solo E.D. coverage. Author of multiple articles in peer reviewed medical journals.
21. Rebecca Rosenberger, MMSc, PA-C, Current President AAPA- Allergy Asthma and Immunology
22. j. Michael Jones, MPAS-C,   Chair PA Section American Headache Society, Director Cascade Neurologic-Headache Clinic..
23.  Pamela Burwell, MS, PA-C. Distinguished Fellow, AAPA . Founder and Director, Peacework Medical Projects. AAPAHumanitarian of the Year. Arizona PA of the Year
24.  Eleanor H. Abel, RPAC, MS, CRC Upstate Medical University, Syracuse.  Director At Large, NYSSPA. Liaison and membership chair for NYRCA. Medical provider with 22 years of experience in Hematology/Oncology and previously employed in Surgery and also Physical Medicine and Rehabilitation. Specialize in pain management, advocacy for people with disabilities, Past coordinator and current assistant coordinator for the NYSSPA Public Education Committee
25. Ronald H. Grubman, PA-C  Founder, Conmed Inc., 1984.  President and CEO for 23 years. Conmed acquired and currently a public company on the NYSE.  
26. Ken Harbert, Ph.D., CHES, PA-C,DFAAPA Dean, School of Physician Assistant Studies. South College, Knoxville, TN
27. Eric Schuman, MPAS, PA-C. Adult & Pediatric Neurology Kaiser Permanente Portland, Oregon.  Adjunct Assistant Professor, Oregon Health & Science University Physician Assistant Program
28. Charles A. Moxin, MPAS, PA-C, DFAAPA, Past President Association of Family Practice Physician Assistants, Past AAPA HOD delegate for Family Practice, Past Editorial Board member for Arthritis Practitioner, Author, National Conference Speaker, Pharmaceutical Advisory Board member
29.  Kenneth E. Korber, PA PhD(c Director of Strategic Development – CE Outcomes LLC, Curriculum Architect – First PA Postgraduate Fellowship in Cardiovascular Care, Clinical Associate University of Illinois College of Medicine, Past Member Board of Directors: Association of PAs in Cardiology, Member – Association of Postgraduate PA Programs, Founder – AAPAMedical Writers Special Interest Group; former Faculty – AAPA Chapter Lecture Series. 
30. Kenneth DeBarth, RPA-C, Past PresidentNYSSPA, Past NYSSPA Newsletter Editor, Past Secretary/Treasurer South Dakota Academy of PAs, founding editor SDAPAnewsletter, past chair AAPA Professional Practices and Relations Committee, former owner Heuvelton Medical Group, NY.
31. Ryan O’Gowan, PA-C, FAPACVS. Acting Manager, NP/PA Critical Care Workgroup. Program Director Physician Assistant Residency In Critical Care Umass Memorial Healthcare 
32. Frank Rodino, PA, MHS, Past Public Education Chair AAPA, Past NYSSPAPresident. Currently President and CEOChurchill Communications: A Medical/Scientific Communications Company
33. Thomas Roselle, PA-C, DFAAPA  PastNYSSPA Consultant, PA Entrepreneur, Clinic Owner. Current Secretary, PAs in Otolaryngology Specialty Group.
34. John Sallis,  MBA, MMS, PA-C   PA consultant -Negotiation management
35. James Doody, PA-C  Director of Pediatrics and Primary Care 1st Health Centers, Assistant Clinical Professor University of Colorado Health Science Center, former Director of Pediatrics Lake Grove School, Editorial Board Member Physician Assistant Magazine, Provider liason Medical Home Initiative for State of Colorado.
36. Karen Fields, MSPAS, PA-C  Founder of Medical Mentoring (medicalmentors. net); Cofounder PAWorld.net 
37. Richard Mayer, PA.  Vice President Provider and Network Development. Lenox Hill Hospital, NY NY
38. Sharon Bahrych, PA-C, MPH, listed in Marquis’s Who’s Who of American Women, published author of 60 lay and medical journal articles, state and national CMEpresenter,co-founder of APAO, clinical trials researcher with a NIH rated grant, currently working on a PhD.
39. George Berry, MPAS, PA-C,DFAAPA. Pediatric Trauma Coordinator  Regional Pediatric Trauma Center, Schneider Children’s Hospital North Shore-Long Island Jewish Health System 
40. Lisa F. Campo, MPAS, PA, DFAAPA  Past President NYSSPA. Former Chief Delegate/ delegate AAPA HOD; former Committee member Wagner College PA Program Advisory and Admission Committees; President LCFC-LLC Consulting; Advanced Clinical Physician Associate the Mount Sinai Medical Center; practicing PA 30years.
41. Kristina Marsack, PA-C, President, Association Plastic Surgery PAs, past-Treasurer, APSPA
42. John W. Bullock, PA-C, DFAAPA. 2010AAPA Federal Service PA of the Year Award Winner.  Past Chief Consultant to the US Air Force Surgeon General for Physician Assistants, Founding member and past Vice President of PAs in Orthopaedic Surgery. 
43. William Gentry, MPAS, PA-C Senior Physician Assistant-Neurology  Audie L. Murphy Veterans Medical Center
44. Harmony Johnson PA-C, MMS  Current President, PAs for Global Health
45.  Chris Hanifin, PA-C. Immediate Past President, new Jersey State Society of PAs.
46. Francis Crosby, Jr, PA-C, MPAS.  Founding member, United Kingdom Association for Physician Assistants (UKAPA); Member of Pilot Program for PA utilization in UK; Advisor to University of Wolverhampton (UK) PA Training program;AAPA; Delegate or alternate for many years, Publications award winner, 1987;  Fellow Member, Society of Air Force Physician Assistants; Past VP of SAFPA; Past Chair of Nomination Committee; Past Chair of Membership Committee; Past BOD member; Associate Member, Royal College of Physicians Edinburgh; Retired from USAFas Lt Col; Former Commander, Medical Operations Squadron.
47.  David L. Patten, PA-C,  COL, SP,TXARNG. Deputy Commander for Texas Medical Command
48. Michael France, CCRC, MPAS, PA-C, Director of Clinical Research, Alamo Medical Research, MAJ USAF Retired 
49. Robert L. Hollingsworth, DHSc, MS, PA-C.  Owner, Sole Provider Red Springs Family Medicine Clinic, N.C. Preceptor for the Physician Assistant Programs at Methodist College in Fayetteville, N.C, Duke University in Durham N.C. and East Carolina University, in Greenville, N.C. Active preceptor for several Nurse Practitioner Programs within the state. Former Instructor: Methodist College Physician Assistant Program
50. James C. Allen, IV, MPAS, PA-C,DFAAPA; Director, Physician Assistant Clinical Training Programs, University of Texas Medical Branch-Galveston/Correctional Managed Care; Former Secretary Bexar County PA Society 2003-2005; Dual Certified Aerospace Physiologist; US air Force Aerospace Physiologist of the Year 2003; Past President Towner-Shafer Society, US Air Force 1993-1994; Retired US Air Force Major
51. Michelle Ederer, MA, RPA-C  Past President, New York State Society of PAs.
52. Cindy Burghardt, MS, PA-C, Nephrology PA for Renal Associates, San Antonio, Texas.
53. Shepard B. Stone, P.A. Colonel, SP,CTARNG. Aeromedical Physician Assistant. Aviation Task Force- Currently deployed-KuwaitPhysician Associate-Yale Medical School
54. Charlene Morris, DFAAPA, MPAS, PA-C, Past President AFPPA, CME Chair SPAP, Past AAPA Liaison to AAFP, Author/Lecturer.
55. Jonathan E. Sobel, RPA-C,FAPACVS President-Association of PA’s in Cardiovascular Surgery
56. Geoffrey Hoffa, PA-C, MHS Board Member of the Arizona Regulatory Board of Physician Assistants.  First PA Associate member American Society of Transplant Surgeons. Past Chair, Public Relations Committee ASAPA, Current member of theAAPA HOD. 
57. Robert M. Chavis, PA Commander / 05USPHS/Army, Past Chairman Academy ofUSPHS Physician Assistants, Past Medical Director USMAPS, Delegate UN World Indigenous People Conference, Wolfclan Chief Nottoway/Meherrin/Tuscarora Nations,
58. Keith G. Plummer MPAS, PA-C, DFAAPADirector of Emergency Medicine, Johnston Memorial Hospital, Oklahoma
59. Joseph A Hlavin PA-C, MS Neurosurgical PA. Former President, Association of Neurosurgical Physician Assistants (ANSPA), 1998 – 2000, 2006 – 2008 AANSNeurosurgeon Editorial Board, American Association of Neurological Surgeons, 5/1/2008 – 4/30/2011.President, Brazos Valley Physician Assistant Association 1/2010 -12/2010
60. Francine Boullosa, PA-C. Past-president and past legislative co-chair Oregon Society of PAs1991-2 AAPA-Burroughs-Wellcome Health Policy Fellow.
61. Richard M. Bishow, MPAS, PA-C, Lead Physician Assistant, Inova Fairfax Hospital Emergency Department, Distinguished Fellow, AAPA, Emergency Medicine clinician for 32 years, Associate Clinical Professor of Health Care Sciences, The George Washington University School of Medicine and Health Sciences, Associate Professor of Emergency Medicine, The Virginia Commonwealth University School of Medicine, Clinical Instructor of Health Care Sciences, Drexel University College of Health Profession, Paragon Award winner (1st Place) for publishing excellence.
62. Michael A. Banuchi, PA-C, MPH: Founder/Owner, PhysicianAssistantForum.Com/PhysicianAssociate.Com, Board of Advisors for National Association of Physician Assistants. Dermatology, Boca Raton, FL.
63. Edward Ranzenbach, PA-C, MPAS, FAPACVS, DFAAPA  Fellow – Association of Physician Assistants in Cardiovascular Surgery (APACVS) Leadership FellowAPACVS Fellow American Association of Surgical PAs Fellow California Academy of PAs Director-at-Large APACVS Board of Directors. Member Fellow Membership Oversight Committee APACVS MemberCME Committee APACVS, Chair – 27th Annual APACVS Winter Educational Meeting Associate Member Society of Thoracic Surgeons
64. Jose’ C. Mercado, MMS, PA-C  President- SPAO-HNS. Adult & PediatricENT Disorders.
65. Professor Steven J. Sager, MPAS, PA-C,DFAAPA Assistant Professor, Physician Assistant Department Nova Southeastern University – Ft. Lauderdale
66. Joel D. Bashore, PA-C, MPAS; LCDR,MSC, USN (Ret); PA/NP Education Coordinator, Carilion Roanoke Memorial Hospital Emergency Dept.; Past Vice-President Naval Association of Physician Assistants
67. Kimberly J. T. Lakhan, MPAS, PA-C,DFAAPA  Otolaryngology, Head & Neck Surgery, Facial Plastic Surgery  and APN/PA Council Chair SMDC Health Systems, Duluth, MN Distinguished Fellow AAPA, Fellow and Past Director-at-Large Minnesota Academy of PAs, Fellow SPAO-HNS
68. Larry Collins, PA-C, DFAAPA, ATC . Instructor, Department of Orthopaedics & Sports Medicine, University of South Florida. USF Sports Medicine and Athletic Related Trauma Institute. United States Olympic Training Program including stints at the 1996 Summer Olympic Games in Atlanta, and at the 2008 Winter World University Games in Torino, Italy. 
69. Michael C. Doll, MPAS, PA-C, DFAAPA, FAPACVS.  Chair of Quality Care Committee – AAPA. Past President –APACVS. Current Candidate for Director At Large – AAPA Director of Physician Assistants Cardiac Surgery Service Line Geisinger Health System, Danville, PA
70. Thomas White, JD, MA, PA-C, Past President TAPA, NMAPA, PA Educator.
71. Denni J. Woodmansee, PA-C.  PA Advisor to the Under Secretary for Health  U.S.Department of Veterans Affairs
72. Lisa Lanning Lowther, MS, PA-C; Assistant Professor, Medical College of Georgia PA Program; Emergency Medicine and Family Medicine PA for 10 years.
73. Carol S. James PA-C. Lead Physician Assistant. Department of Neurosurgery. The Johns Hopkins Hospital
74. Richard C. Davis , P.A.  Chief PA,RRMC. 35 years of PA practice.  Salisbury, NC
75. Matthew Andersen, PA-C, MPAS, FAPACVS Department of Cardiothoracic Surgery, Virginia Mason Medical Center Seattle, WA
76. Rudolph (Rudy) Balli, MPAS, PA-C ”Physician Associate” (University of Oklahoma), Captain, USAF, Retired.  Audie L. Murphy Veteran’s Memorial Hospital
77. Alex K. Harris, PhD, PA-C, Southern Cardiopulmonary Associates, PC, LaGrange, GA; ApolloMD Emergency Physicians, Atlanta
78.  Vee S. Yoong, PA-C, MS, Ph.D. Providence St. Peter Hospital. Emergency Medicine, Olympia, Washington. American Heart Association ACLS Regional Faculty/Course Director/Instructor. Advance Cardiac Life Support – (ACLS-EP) Instructor, Katrina Hurricane Relief Volunteer medical worker, American Red Cross, PA Consultant. Initial groundwork & program design for Pacific University Physician Assistant Program, Forest Grove, Oregon. 
79. Reginald L. Smith, PA-C, Past Vice-President and Past Director-at-Large Bexar County PA Society, San Antonio, Texas. 
80. David N. Pellin, PA-C, FAAPA;  Past Clinical Director Indian Health Service, Wellpinit Service Unit, Spokane Reservation, 2007 – 2010; Clinical Preceptor, University of Washington School of Medicine MEDEX Northwest, 2008 – Present University of Washington School of Medicine MEDEX Northwest, Cum Laude graduate, 2005 – 2007
81. Bob Sammartano, RPA-C  Program Director  Postgraduate Residency in Surgery for PAs Montefiore Medical Center  President Elect AASPA. Chief Delegate for Surgery –AAPA HOD
82. Lawrence Russell, P.A. Founding President, Society of Air Force PAs. Former Associate Chief of PAs, USAF. PA for 38 years. 
83. Ken Phillis MPAS PA-C. Past Board member, PAC member, and Legislative Affairs Committee of the Texas Academy of PAs Retired, United States Army.
84.  Glen E. Combs, MA, PA-C Former President of the AAPA. NCAPA Board Member-Chapter President. ’73 Graduate – AB College
85. Cheryl E. Gregorio, PA-C, MPAS, DFAAPA; PAragon winner Federal Services PA of the Year and Veteran’s Caucus PA of the Year ; 28 years practice;  Degree as a Physician Associate, OU.
86. Jackson R. Dobbins, Colonel, USAF, Ret (2009) Med College of GA Class of ‘78 Fellowship, Montefiore Med Cntr, NYC– Emer Med /79-80. 1st AF PA on operational support flying status, AFSOC(Graduate of Flight Surgeon/APA School, Ft. Rucker 1997). 1st PA as Combined Special Operations Task Force Surgeon Operation DESERT THUNDER. 1st PA as Medical Group Commander inUSAF. Legion of Merit, Bronze Star (OIF),MSM x 6, JSCM, AFAM.  AAPA, SAFPA, SOMA (Spec Ops Med Association), Montefiore Alumni Association
87. Jo Ann Cutler Friedrich, P.A.-C Stanford University, 1976 – Author of The Pre-Menstrual Solution, Arrow Press, Inc. 1987 and Sleep Matters, Bright Books, 1995. Over 350 national and regional TV and radio programs,  Published in USA Today and the Chicago Tribune. 
88. Steven Engelberg, PA-C, PhD. University Medical Center, Las Vegas, NV Dept. of Emergency Medicine. VP / Founder National Association of Physician Assistants, Past President Nevada Academy of Physician Assistants. Assistant Professor, Touro University, NV
89. Herve Poulard, PA-C Medical Attache’. US Embassy Santo Domingo
90. Brian R. Bea, APA-C, MPAS. Aeromedical P.A. LTC, Oregon Army National Guard. 16 Years experience in Family and Emergency Medicine
91. Terry Mathews, Lt Col, USAF, BSC, PA-C1.  Pres-Elect, Society of AF PAs. 1998AMSUS PA Award winner  1998 SAFPAWheaton Award winner  2005 Air Mobility Command PA of Year
92. Ellen Britt, PA, EdD. Online Marketing Expert and Consultant and Co-founder of MarketingQi.com. Ellen specialized in Emergency Medicine/Urgent Care and Occupational Medicine for more that two decades and is a graduate of one of the first speciality PA training programs in the country, the Robert Wood Johnson Emergency Medicine Postgraduate Program at Maine Medical Center, Portland. She lives and works near Atlanta, Georgia.
93. Jennifer Moore, PA-C  Past AAPA Board Member. Past President NYSSPA. !975 Graduate of Stony Brook Physician Associate Program.
94.  Ed Friedmann, PA  AAPA Past President. Past Chair, Iowa PA Regulatory Board. Federally Certified Rural Health Clinic PA for many years.
95. Jefferey Nicholson, PhD, PA-C, DFAAPA. President American Academy of PAs in Legal Medicine, Board Member, Wisconsin Academy of PAs,
96.  James Taft, MPAS, PA-C.  JAAPA Board Member,  CHSC Member and QCC Member
97. George (Rick) Hillegas, PAC, MPH. Ist PA Class GW University. AAPA Health Policy Fellow 1992, Retired US Coast Guard PA.
98. Bud Shelton, PA-C Past President North Carolina Academy of PAs. Graduate Duke University Physician Associate Program. 30 years Pulmonary Medicine, Ambulatory Surgery 15 years , Durham NC.
99. Glen Sikes, PA-C  SUNY Stony Brook, 1977 Former Director of Surgery, Lower Florida Keys Health System, Key West Florida. 33 years combined ER/OR experience. Presently in primary care in rural North Carolina.
100. Ernest W. Edmonds, PA-C, MPAS. SAFPA President – 1983-84. SAFPA Secretary / Treasurer 1985 – 1993(?), Program Director,USAF PA Program 1988 – 1991.  Clinic Director, VA Outpatient Clinic (Contract) 1995 – current

[Rondaben]

Thank you EMEDPA, I appreciate the response!  You make great points and you obviously have a lot more experience than I do. There is definitely a problem, I agree completely with you and Cideous on that, but I think that I was putting the emphasis for that on a lower priority.   Yes, language and titles matter, there is no denying that.

I am still learning much about the practicalities of all of this, that I admit to as well.  One thing I perceive--perhaps wrongly--is that there isn't a cohesive goal at the end of the day.  If we look at NPs for example I would venture to say that the overwhelming majority support the central idea of independence from docs.  That cohesiveness is what drives their success because it is backed up by cash.  RIght or wrong its not often the ideology that wins in the end, it is the size of the donation or the number of votes that can be delivered.

Its clear that there is frustration on all sides.  I understand the arguments for OTP, name change, expanding the scope of practice as our training intensifies and we add more and more qualified skills, etc.  I completely agree with them.  The language of the TMAs agenda sounds as though it is in closer alignment to OTP than before and most of their ire is directed squarely at NPs.  What is happening in Texas is more splashback from that situation. 

Thank you again for the info!