AFPPA's response to the AHA White Paper

[andersenpa]

AFPPA Letter:

 

John Combes, MD

Senior Vice-President

AHA

155 N. Wacker Drive

Suite 400

Chicago, IL 60606-1725

 

January 31, 2013

 

Dear Dr. Combes,

 

I am writing on behalf of the Family Practice Physician Assistants in regards to the recent White Paper on “Workforce Roles in a Redesigned Primary Care Model.” As the President of the AFPPA, I read this report with great interest as I felt this report to be germane to my profession, the constituents I represent, and the patients we serve.

 

When reading the title, one might have expected all three professions that are licensed to provide primary care in the United States (Physicians, Physician Assistants, and Nurse Practitioners) would have been brought together to develop these recommendations. As I read the report, however, it became evident that no Physician Assistants took part in the creation of the recommendations. Am I wrong in this assumption? Do any of the panelists work in primary care? Do any of the panelists work with a PA? There are no PAs listed as panelists nor is there any reference to PA research. I am writing to help explain why it is important to include all of our professions in your discussions on primary care, especially when PAs will be the solution to many of the shortages that are expected with the full implementation of the ACA in 2014.

 

According to the American Academy of Physician Assistants (AAPA) there are nearly 90,000 certified PAs with approximately 6,000 new graduates every year making the Physician Assistant profession the fastest growing healthcare profession in the United States. There are an additional 80 PA programs expected to open by 2016 with a projected 10,000 PAs (per year) entering the workforce by 2020 to help offset the physician shortage. PAs are already responsible for millions of patient visits every year. PAs work in a variety of settings: solo practices (some of which are PA-owned), long-term care facilities, hospital emergency rooms, and any place you would find a physician or APRN. Although the report points out “the physician assistant diagnoses and oversees the plan of care under physician supervision” it does not recognize that we, too, see complex cases similar to our physician and APRN colleagues. There is no mention that APRNs must also work in collaboration with a physician and many still work under the supervision of a physician depending on state guidelines. One may read this report and assume that PAs are incapable of autonomy or handling the wide range and complexity of healthcare problems that we, in fact, manage on a daily basis. In 2010, a study funded in part by the Agency for Healthcare Research and Quality found that “Primary care patients who see physician assistants and nurse practitioners are as complex as those who see doctors.” (http://www.ahrq.gov/research/apr10/0410RA24.htm) Physician assistants in primary care collaborate with our physician and nurse colleagues. In primary care, we (PA, NP, MD, DO) are generalists, and in a team setting we utilize each other’s knowledge to improve care regardless of our respective professional titles.

 

The report also includes “Issues that are Impacting Progress” which lists pipeline issues for APRN faculty shortages but fails to mention the faculty shortages impacting the PA profession, which is growing at an even faster rate than APRNs. If the AHA is to understand the primary care workforce limitations which will impact the progress of change, they must understand that PAs are also facing limitations on faculty, preceptor sites, and state licensing acts that restrict our full scope of practice. For example, the “Continuum of Care” model lists Palliative Care/Advanced Illness Management as part of the health issues to be provided by primary care. When almost half of the providers in primary care (PAs and APRNs) are not permitted by federal law to provide referral to HomeHealth and Hospice care, won’t this severely limit the ability of this model to be effective?

 

In the Behavioral Health section of the key components of Prevention/Wellness, it states that the AHA will “Engage psychiatrists, geriatricians and APRNs in primary care practices to serve as behavioral health consultants and educators.” PAs also work in the fields of psychiatry, geriatrics and primary care managing psychiatric illness every day. Although these omissions appear unintentional, please realize that when legislation has been enacted in the past, these omissions have ultimately led to further restrictions in the ability of PAs to practice within the full scope of our licenses.

 

The final page of your report is titled “A Call to Action”. Family practice PAs make up a large number of providers who will be expected to respond to this call. As the leader of primary care PAs, I would welcome the opportunity to discuss with the AHA how we can work together toward a primary care model that represents all primary care providers and further the AHA’s understanding of who PAs are, our ability to practice complex medicine and how we will be part of the solution to health care provider shortages in the future.

 

If you feel it would be appropriate, I would be happy to meet with you and the panel to discuss the role of PAs in healthcare and recommend exceptional PA leaders to meet with you on any future panels pertaining to primary care.

 

Sincerely,

 

 

 

Beth R. Smolko, MMS, PA-C

President, Association of Family Practice Physician Assistants 2012-13

smolko@yahoo.com

301-466-0446

 

 

The AHA Report:

 

http://www.aha.org/content/13/13-0110-wf-primary-care.pdf

[LT_Oneal_PAC]

Awesome response

[Boatswain2PA]

Outstanding

[primadonna22274]

Good response.

Is anyone else bothered by the fact that this report is dated Nov 2011 and we have just been discussing how it ignores us the past few weeks?

[Hemegroup]

Good response.

Is anyone else bothered by the fact that this report is dated Nov 2011 and we have just been discussing how it ignores us the past few weeks?

 

Well, no time like the present! Time to ship shape.

[physasst]

Actually they met in September 2011, but the report on the very bottom was dated January 2013.

 

At least the one I read I should say.

 

Also, my colleague here, who is a board member of the AHA, had indicated that was just released this last month.

 

"©2013 American Hospital Association" at the bottom of the report.

[primadonna22274]

Oh, that is a relief, thanks Mike ;)