Remove Administrative Hassles for Collaborating PAs, Docs

In my day job, I practice as a PA in both general, plastic, and reconstructive surgery. I have also had a long career of serving in my profession’s leadership on the state, national, and specialty level.

During my career, I have personally witnessed the transition from “What is a PA?” to PAs being a vital and indispensable part of the health care system in the U.S. and around the world. Saying that the PA profession of 1981 is nothing like the PA profession of 2018 is a massive understatement.

My current role in leadership is to serve as the American Academy of PAs’ (AAPA) liaison to the American Medical Association. The AAPA and AMA have a longstanding and mutually beneficial relationship. We have grown together as organizations and as professions.

Optimal Team Practice (OTP) is a policy initiative by the PA profession that seeks to remove the administrative hassles and shared liability currently faced by physicians who practice with PAs. As PAs, we have always and will always be committed to team practice. We are trained and acculturated to the medical and surgical team practice environment, and we thrive in that environment. Part of OTP is removing requirements that every physician and PA who practice together document their relationship in a manner that is acceptable to the state. It's also about freeing physicians from vicarious liability for the care PAs provide. Removing these requirements will not change the PA profession’s commitment to practice with physicians.

At the 2017 Interim House of Delegates, in response to AAPA’s OTP initiative, the AMA essentially reaffirmed long standing policies as they relate to PAs and other non-physician providers. They also requested an in-person meeting to look at trends in scope of practice for providers who are not physicians.

The Physician Assistant Education Association's role is to represent those responsible for educating and preparing PAs to take their place in the health care system. Recently, AAPA President Gail Curtis participated in a Q&A with PAEA about OTP.

While there are many elements to OTP that I will discuss in future blogs, the question of how a “new grad” would handle this loosening of the tie to a specific physician vs. a seasoned PA is one I hear a lot. This is not unlike every element of the team practice of medicine. We don’t throw first year residents to the wolves any more than we throw a new PA graduate into the fire on their first day on the job.

All clinicians learn to become effective team members and competent, knowledgeable providers one step at a time. At the beginning of training and experience in practice, physicians in training, new PA graduates, and other providers have limited autonomy and responsibility for a reason. It takes experience to recognize disease patterns and their presentations. Learning to be an effective team player takes time, too.

As physicians, PAs, and other providers gain clinical experience, they shoulder more responsibility and autonomy because the team recognizes their experience and progression. That is what OTP is all about - allowing decisions about provider autonomy and responsibility to be made at the practice / team level, and not at a state law level. One size does not fit all for either physicians or PAs.

As a longstanding PA, I can tell you, AAPA President Gail Curtis has it exactly right when she says:

“Under the new (OTP) policy, new graduates and early career PAs, as well as PAs who are changing specialties, would continue to practice in teams with physicians, and their scope of practice would be determined at the practice level. Regardless of whether a PA is early career, changing specialty, or simply encountering a condition with which they are unfamiliar, the PA is and will continue to be responsible for seeking consultation as necessary to assure that the patient’s treatment is consistent with the standard of care. This is part of the definition of a professional - to take responsibility for assuring that the patient’s care is appropriate. As a profession, this is not new for PAs.”

This is the way in which experienced PAs have been operating for decades. It is not a “scope of practice” issue, but an efficient “team practice” issue. PAs have always been a solution to the quality of physician life issue. Just ask any physician with experience working on teams with PAs. Removing the administrative hassles associated with working with PAs improves patient safety, quality of care, quality of life for all, and is in the best interest of physicians working with PAs.

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