Legislators count on physicians, physician assistants (PAs), and nurse practitioners (NPs) to provide them with accurate information and quality suggestions for improving health care. The problem is, each group has its own agenda and interests that may or may not actually be good for health care.


I have been involved in healthcare politics in Texas for about 15 years. It seems like a complicated mess, but I think I can summarize the greater issues with each group and how they impact
 our policymaking process. These are broad generalizations, because explaining the issues in detail in these 600 or so words is impossible.


PAs’ legislative desires are hampered by the belief they have to go to physicians for “permission” to try to change healthcare policy. They are also encumbered with being lumped in with NPs as being “the same thing.”


NPs want independent practice. Everyone knows it but the words are rarely spoken out loud because the idea is so volatile. This issue alone colors everything they attempt to do at the political and regulatory levels.


Physicians want to be in charge of everything “medicine.” The Texas Medical Association even refers to itself and its members as “medicine.” Physician organizations will often do things under the guise of “patient safety” that are, in fact, only to protect the control of medicine and the associated financial rewards.


By now many people are offended by my suppositions. Keep in mind these are generalizations and are mostly in regard to the regulatory and political aspects of health care. I have friends and colleagues in each profession and believe the overwhelming majority are caring professionals who only want the best for their patients. However, I have also seen wonderful providers become merciless idealogues when they enter the capitol building.


So what is my point? The process of providing health care has been corrupted by personal interests. As health-care dollars get smaller and regulation gets bigger, this has only worsened.


I recently had the privilege of participating in a think-tank type of group. The group’s only mission is to improve health-care quality, access and costs. This group disallows any personal agendas. Everyone is on equal footing, free to introduce any idea that might meet the stated goals. Over a period of 18 months or more broad concepts are developed, then refined, then fine-tuned and an action plan is made. Each participant then goes back to his or her home base to promote these ideas.


I found two things most interesting about this group. The first was the concept that every idea was worth discussing and possibly adopting if it was good for health care. The second was the makeup of the group, which included CEOs of hospital systems, vice-presidents of insurance companies, PAs, NPs, physicians, legislative aides, representatives of hospice and home-health organizations and more.

After spending years clawing and fighting to get the simplest things done legislatively, I saw, in its purest sense, what health-care policymaking could be like, absent self-interest. It renewed my faith in what I had come to believe was a terminally flawed system.


So my question is this: Is it possible for all of us to rise above our own interests and the interests of our respective groups, and try to fix the health-care system by working together? I dare to dream.

Scott Stegall, PhD, PA-C, is an Army-trained PA and COO of the Physician Assistant ­Political Alliance. He practices in rural health.