NEW PAFT Statement

[EHOLDENPA-C]

A Statement On The “Highest Level” of PA Practice

 

PAs for Tomorrow

April 2013

 

It has often been quoted by health policy experts, medical opinion leaders and others, that health professionals need to function at the “top of their license”; the highest level of their education and training. PAs for Tomorrow fully agrees. We believe that PAs need a framework that creates this end state. To that end, “PAs for Tomorrow” endorses a model that supports the “highest level of PA practice” for the profession in 2013.

 

To practice at the “highest level” of PA practice:

1. The PA is licensed to practice medicine and is regulated in their state by a freestanding Board of PA Medicine or Examiners or an autonomous PA board under the BOM.

2. The PA is an autonomous medical care provider that is both a team member and team player. The PA collaborates with physicians and also other healthcare professionals whenever appropriate and the PA is responsible for the medical care the PA provides.

3. PAs can manage, supervise, run and own clinics, offices and other sites that deliver healthcare as to increase access to that care. State regulations that are barriers to that goal should be responsibly removed or minimized.

4. Any barriers to PA practice such as chart review, co-signatures, ratios, geography, etc., must be proven by evidenced based research to actually improve care and not be a barrier for access to PA care. State regulations that are old and antiquated should be removed if not proven to increase PA quality of care.

5. PAs may be allowed to become partners in the medical practices or groups by the removal of state corporate limitations and restrictions.

6. PAs are encouraged to know their productivity and become familiar with whatever metrics are used to measure their work.

7. For those PAs with hospital privileges, the credentialing and privileging process shall be the same for PAs as for all other staff members. No arbitrary restrictions shall be placed on PA practice. A PA shall be able to practice any task or procedure for which they have demonstrated education and competence. PAs must be members of the credentialing committee and be a voting member for all PA credentialing/privileging matters. Hospital based PAs should be considered medical staff.

8. The PAs name and credentials are listed publicly along with physicians, NPs and other professionals with whom they practice.

9. PAs are empanelled by insurance companies by specialty and all insurance restrictions of PA practice are removed.

9. PAs are allowed by federal rules and regulations as well as ACOs and insurance organizations to lead a patient centered medical home (PCMH).

10. Ideally, the PAs name will change to be representative of their profession which is not one of an “assistant,” but a full clinician and/or associate.

11. The relationship with their patients is the one the PA holds as the highest. The patient and their needs as individuals are primary and above relationships with physicians and other health care providers.

 

The Board of Directors of the PAFT realizes that not all of these criteria will be met in every location in which PAs practice, but feels strongly that these should be the ideals that PA leaders look towards providing the PAs in their states as PAs join a practice or new employment situation. Putting the above suggestions in place would provide the PA profession with the greatest ability to make a difference to the American people who need access to high quality, cost effective patient care.

 

http://www.pasfortomorrow.org

[rcdavis]

Nice, very nice. Good tone. I like it.

[rcdavis]

Nice, very nice. Good tone. I like it.

[ToppDog]

I was gonna say "Ditto" but I need more words... So, "What he said" :)

[ToppDog]

I was gonna say "Ditto" but I need more words... So, "What he said" :)

[Boatswain2PA]

At the risk of pi$$ing off half of the readers of this forum (again)......

 

There is nothing in this statement about us working FOR physicians. We're "autonomous", we "collaborate", and we're "responsible for the care that we provide", but where is the physician in all of this?

 

Makes me think that PAFT is striving for independent practice. Is that the goal? If not, then PAFT should clearly state that we are autonomous yet dependent medical providers. If it is the goal, then they should clearly state it.

[Boatswain2PA]

At the risk of pi$$ing off half of the readers of this forum (again)......

 

There is nothing in this statement about us working FOR physicians. We're "autonomous", we "collaborate", and we're "responsible for the care that we provide", but where is the physician in all of this?

 

Makes me think that PAFT is striving for independent practice. Is that the goal? If not, then PAFT should clearly state that we are autonomous yet dependent medical providers. If it is the goal, then they should clearly state it.

[Guest Paula]

Read point # 2. We collaborate with physicians and others.... Currently not striving for complete independence but certainly autonomous providers who do not need restrictive supervised practices. Collaboration.

[Guest Paula]

Read point # 2. We collaborate with physicians and others.... Currently not striving for complete independence but certainly autonomous providers who do not need restrictive supervised practices. Collaboration.

[Boatswain2PA]

I read the "collaborate", but that doesn't infer any type of physician primacy.

 

And you say "Currently" not striving for "complete independence". Does that mean the long term goal of PAFT is independence?

[Boatswain2PA]

I read the "collaborate", but that doesn't infer any type of physician primacy.

 

And you say "Currently" not striving for "complete independence". Does that mean the long term goal of PAFT is independence?

[Guest Paula]

No, we understand the importance of physician collaboration and the expertise they provide. We are looking for collaboration without restrictive supervision laws that hamper our ability to care for patients. See #4 and #7. Bottom line: let us manage our own affairs within the medical community, and not have another profession decide what we can and cannot do. See # 1.

[Guest Paula]

No, we understand the importance of physician collaboration and the expertise they provide. We are looking for collaboration without restrictive supervision laws that hamper our ability to care for patients. See #4 and #7. Bottom line: let us manage our own affairs within the medical community, and not have another profession decide what we can and cannot do. See # 1.

[Boatswain2PA]

I am only a voice of one here, and I would like there to be an organization that truly represents the PA profession (I don't believe the AAPA does anymore), but it seems like this statement is a bit weak on the physician - physician assistant relationship. This statement could easily be read to mean that PAFT is trying to move closer to the NP/DNP model of "we don't need no stinking doctors", and I think that would be a mistake.

[Boatswain2PA]

I am only a voice of one here, and I would like there to be an organization that truly represents the PA profession (I don't believe the AAPA does anymore), but it seems like this statement is a bit weak on the physician - physician assistant relationship. This statement could easily be read to mean that PAFT is trying to move closer to the NP/DNP model of "we don't need no stinking doctors", and I think that would be a mistake.

[drholmes]

At first read and re-read; I love the way this is written. In the world of medical hierarchy and regulators you have to push hard for (and, usually for a little more than) what you are attempting to ideally achieve in order to get what you seek. Physician extending personnel (those licensed to practice medicine) - we are extensions of the physician - need the wiggle room to be able to act on behalf of the physician. We also need the hierarchical and regulatory foundation from which to operate effectively from. In my view, PAFT does not seek for complete independent practice - the main reason I joined their group as a student. They seek, to whatever logical level attainable, to create an environment where the PA can practice to the maximum level of their training/experience/aptitudes. Such an environment is not in the majority from a State or National legislative perspective. In addition, many in our collaborative circles do not see us as full partners. Both fronts need to be tackled with gusto.

 

If some want true independence and know exactly what you want to do with it; then please go back to school and become physicians and contribute from that angle. I haven't even started practice yet and am I am filled with wonder at the opportunities that await me in the practice of medicine as a PA. I want to be a PA! PAFT is an organization that is trying to preserve what Dr. Stead envisioned. BTW, I don't own any rose-tinted spectacles and am prepared for the naturally occurring headaches associated with being a professional and caring for patients - been in medicine for too long not to see them for what they are.

 

Thanks to Jim, Bob, Eric, Paula and company for creating this much needed collection of like-minded practitioners of medicine.

[drholmes]

At first read and re-read; I love the way this is written. In the world of medical hierarchy and regulators you have to push hard for (and, usually for a little more than) what you are attempting to ideally achieve in order to get what you seek. Physician extending personnel (those licensed to practice medicine) - we are extensions of the physician - need the wiggle room to be able to act on behalf of the physician. We also need the hierarchical and regulatory foundation from which to operate effectively from. In my view, PAFT does not seek for complete independent practice - the main reason I joined their group as a student. They seek, to whatever logical level attainable, to create an environment where the PA can practice to the maximum level of their training/experience/aptitudes. Such an environment is not in the majority from a State or National legislative perspective. In addition, many in our collaborative circles do not see us as full partners. Both fronts need to be tackled with gusto.

 

If some want true independence and know exactly what you want to do with it; then please go back to school and become physicians and contribute from that angle. I haven't even started practice yet and am I am filled with wonder at the opportunities that await me in the practice of medicine as a PA. I want to be a PA! PAFT is an organization that is trying to preserve what Dr. Stead envisioned. BTW, I don't own any rose-tinted spectacles and am prepared for the naturally occurring headaches associated with being a professional and caring for patients - been in medicine for too long not to see them for what they are.

 

Thanks to Jim, Bob, Eric, Paula and company for creating this much needed collection of like-minded practitioners of medicine.

[Febrifuge]

I like it -- I like parts of it a lot, and I'm proud to be a Founding Member of PAFT -- but I think Boatswain has a good point.

 

If I were writing this, I'd put the final paragraph up above, and specify even more clearly at the outset that this is an ideal set of conditions and circumstances, something to strive toward and use as guidance while making and adjustingn policy. As-is, it reads like a list of -- I hate to use the word demands, so let's say wishes -- that are meant to be completed "in 2013." I understand that the intent is to say, "yo, it's 2013, and the profession has evolved, so the rules should reflect that," but it can be interpreted as "this is where we need to get to in 2013."

 

I'd also be a whole lot more specific about where and by whom it "has often been quoted" that this "top of the license" deal is a priority and a factor. I agree, and I think you're talking about the NP's again and one more way in which they've been able to run rings around us in the past, but having a nice solid statement out of a reliable source would be much more powerful. (I currently find myself thinking of the very end of Raiders of the Lost Ark, where the government guys assure Marcus and Indy that the Ark is safe, and being studied by "Top Men." Indy asks, "who?" and all they can say is, "Top. Men.") There's a rhetorical bump to get over, where you need to convince the reader that this is important; once you secure that buy-in, you enumerate your steps for achieving this worthy goal.

 

As I say, it's really, really good; I just feel it could be better, clearer, maybe even more powerful while also being less... intense. I'd be happy to do a Joss Whedon style "punch-up-and-polish" on anything for PAFT in the future, if you like.

[Febrifuge]

I like it -- I like parts of it a lot, and I'm proud to be a Founding Member of PAFT -- but I think Boatswain has a good point.

 

If I were writing this, I'd put the final paragraph up above, and specify even more clearly at the outset that this is an ideal set of conditions and circumstances, something to strive toward and use as guidance while making and adjustingn policy. As-is, it reads like a list of -- I hate to use the word demands, so let's say wishes -- that are meant to be completed "in 2013." I understand that the intent is to say, "yo, it's 2013, and the profession has evolved, so the rules should reflect that," but it can be interpreted as "this is where we need to get to in 2013."

 

I'd also be a whole lot more specific about where and by whom it "has often been quoted" that this "top of the license" deal is a priority and a factor. I agree, and I think you're talking about the NP's again and one more way in which they've been able to run rings around us in the past, but having a nice solid statement out of a reliable source would be much more powerful. (I currently find myself thinking of the very end of Raiders of the Lost Ark, where the government guys assure Marcus and Indy that the Ark is safe, and being studied by "Top Men." Indy asks, "who?" and all they can say is, "Top. Men.") There's a rhetorical bump to get over, where you need to convince the reader that this is important; once you secure that buy-in, you enumerate your steps for achieving this worthy goal.

 

As I say, it's really, really good; I just feel it could be better, clearer, maybe even more powerful while also being less... intense. I'd be happy to do a Joss Whedon style "punch-up-and-polish" on anything for PAFT in the future, if you like.

[Febrifuge]

...Physician extending personnel (those licensed to practice medicine) - we are extensions of the physician - need the wiggle room to be able to act on behalf of the physician. We also need the hierarchical and regulatory foundation from which to operate effectively from.

 

As a total tangent, I had to smile at this because for some of us, the term "physician extender" is a term that's fraught with contention and bitterness. Things may be different in your region of the US, but I personally hate the term, and feel that it encompasses a lot of what's wrong with the current state of affairs. In fact, I'd go so far as to say that PAFT is about changing the perception of anyone who feels that being a legally dependent practitioner means being someone else's "extender," "helper," or "assistant." But like I say, that's a tangent, and it's great that you've joined up as a student.

 

Thanks to Jim, Bob, Eric, Paula and company for creating this much needed collection of like-minded practitioners of medicine.

Absolutely no argument here. This is a worthy endeavor, and one I'm passionate about (obviously). It's a very good group, with a good plan and a good approach. That's why I want everything to be as effective as possible.

[Febrifuge]

...Physician extending personnel (those licensed to practice medicine) - we are extensions of the physician - need the wiggle room to be able to act on behalf of the physician. We also need the hierarchical and regulatory foundation from which to operate effectively from.

 

As a total tangent, I had to smile at this because for some of us, the term "physician extender" is a term that's fraught with contention and bitterness. Things may be different in your region of the US, but I personally hate the term, and feel that it encompasses a lot of what's wrong with the current state of affairs. In fact, I'd go so far as to say that PAFT is about changing the perception of anyone who feels that being a legally dependent practitioner means being someone else's "extender," "helper," or "assistant." But like I say, that's a tangent, and it's great that you've joined up as a student.

 

Thanks to Jim, Bob, Eric, Paula and company for creating this much needed collection of like-minded practitioners of medicine.

Absolutely no argument here. This is a worthy endeavor, and one I'm passionate about (obviously). It's a very good group, with a good plan and a good approach. That's why I want everything to be as effective as possible.

[Guest Paula]

A reference I suggested to include with the statement: What is Driving U.S. Health Care Spending? AMerica's Unsustainable Health Care Cost Growth. pp. 20-21. "Due to various regulations and restriction, many professional are not practicing at the "top of their license", meaning that they are not performing the work that reflects the fullest extent of their education and training. HTe time that a physician spends performing a task that a nurse practitioner (NP), physician assistant (PA), pharmacist or other health professional is qualified to perform drives up health care costs unnecessarily. .......When and NP or PA can provide the same care to a patient safely and effectively, engaging a physician for this service is a missed opportunity to utilize a lower cost provider." It goes on for a few more sentences.

 

The statement is a working document for PAs to use with their state organizations to expand SOP and remove barriers that do not increase patient access or prevent PAs from practicing medicine effectively.

 

We welcome all suggestions and feedback. We know everyone will not agree with the statement but hope you can all take parts of it, and incorporate into your state advocacy for PAs.

[Guest Paula]

A reference I suggested to include with the statement: What is Driving U.S. Health Care Spending? AMerica's Unsustainable Health Care Cost Growth. pp. 20-21. "Due to various regulations and restriction, many professional are not practicing at the "top of their license", meaning that they are not performing the work that reflects the fullest extent of their education and training. HTe time that a physician spends performing a task that a nurse practitioner (NP), physician assistant (PA), pharmacist or other health professional is qualified to perform drives up health care costs unnecessarily. .......When and NP or PA can provide the same care to a patient safely and effectively, engaging a physician for this service is a missed opportunity to utilize a lower cost provider." It goes on for a few more sentences.

 

The statement is a working document for PAs to use with their state organizations to expand SOP and remove barriers that do not increase patient access or prevent PAs from practicing medicine effectively.

 

We welcome all suggestions and feedback. We know everyone will not agree with the statement but hope you can all take parts of it, and incorporate into your state advocacy for PAs.

[Guest Paula]

^^^^ Excuse my typos! The reference is from the Bipartisan Policy Center who published the paper in September 2012. Primary author Dr. Paul Ginsburg. Leadership of the BPC: Tom Daschle (D-SD), Bill Frist (R-TN), Pete Domenci (R-NM) and former Congressional Budget Office Director Dr. Alice Rivlin. Paper partially funded by Robert Wood Johnson and Peter G. Peterson Foundations. It is worth the read.

[Guest Paula]

^^^^ Excuse my typos! The reference is from the Bipartisan Policy Center who published the paper in September 2012. Primary author Dr. Paul Ginsburg. Leadership of the BPC: Tom Daschle (D-SD), Bill Frist (R-TN), Pete Domenci (R-NM) and former Congressional Budget Office Director Dr. Alice Rivlin. Paper partially funded by Robert Wood Johnson and Peter G. Peterson Foundations. It is worth the read.