Q: Have there been other public health issues that have affected physician assistants: vaping illnesses, opioid overdoses, gun violence, climate change (natural disasters)? 

A: PAs practice in every medical setting and specialty, which puts them on the front lines of all public health issues in our nation. Unfortunately, there are sometimes outdated legislative barriers to ensuring PAs can practice to the top of their education, training, and experience. Our job at AAPA is to advocate to remove these barriers wherever we can so that PAs can contribute more.

For example, related to opioid use disorder, AAPA successfully advocated for permanently extending the waiver program that allows PAs to prescribe buprenorphine. This ensures that PAs will continue to play a vital role in the fight against the opioid crisis.

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During disasters or in times of crises, it’s especially important for PAs to be able to mobilize and participate in the response. PAs are always willing to help, but often face legislative roadblocks. For example, in most states, PAs must have an agreement with a specific physician to practice. But, when the PA volunteers at a disaster site in another state, maybe after a hurricane, the physician they have an agreement with may not be willing to maintain the agreement during the PA’s time volunteering. That’s a barrier that just doesn’t make sense, since it prevents PAs from helping out where they’re needed most. 

Also, most “supervision” barriers, like chart review, which a few states still mandate, are done a week or even weeks later, after the patient has been seen, treated, and has gotten better. These rules were mandated 40 years ago when we were an experiment. They no longer work.

That’s a big part of the reason why removing requirements for PAs to have a relationship with a specific physician is reflected in our efforts to advance Optimal Team Practice.

Q: Addressing health care disparities has been a major focus in recent years. How has AAPA helped its members address this issue?

A: One of AAPA’s core values is eliminating health disparities and barriers to quality health, and AAPA’s Policy speaks directly to this issue in numerous ways.

That vision and those policies guide our everyday work. For example, a lot of our AAPA CME addresses disparities. That way, we know PAs are being reminded that it’s part of our job as a profession to work toward eliminating health disparities.

Most recently, AAPA staff and other PAs assessed a quality improvement initiative designed to highlight awareness of health disparities and improve healthcare practices among participants. This work resulted in an article published in the Journal of the American Academy of PAs (“Improving health disparities in PA practices: A quality improvement initiative”).

Q: What has the COVID-19 pandemic taught you about PAs’ readiness for an emergency?

A: The past few weeks have been extremely difficult for a lot of people, but particularly for PAs on the front lines, which in some way has become almost all of us. I have been so inspired by PAs…by their overwhelming desire to respond to the COVID-19 pandemic. Not sure if you know this, but we have had at least 5 PAs pass away so far battling this disease. I have heard rumors of others. I don’t think we are finished yet. They are as much Purple Heart winners as anyone. They died fighting a war. I am a veteran and believe this.

So, although there are some barriers we’re working to address at the state and federal level, PAs have proven beyond a shadow of a doubt that they themselves are more than ready to jump in during an emergency. PAs are trained as medical generalists, so they are more than capable of testing, diagnosing, and treating patients with COVID-19. I’ve also seen so many PAs working together to figure out how they can do more, sharing resources, and providing moral support for each other.

Unfortunately, in many states and the VA, PAs are required to have a supervisory or collaborative agreement with a physician to practice. Unfortunately, these agreements complicate where and how PAs may practice, sometimes preventing them from stepping in where they’re needed most.

Just 4 states (Maine, Michigan, New York, and Tennessee) have recently waved physician supervision requirements in executive orders related to COVID-19. And although 14 states have previously removed physician supervision requirements for PAs during emergencies or disasters, that still leaves the majority of states without this crucial provision.

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To mobilize the full PA workforce, more states need to waive these supervision or collaboration requirements, and they need to do it immediately. AAPAs is calling on all governors to include language in executive orders waiving physician supervision or collaboration requirements during a declared public health emergency or disaster. There is no time to lose.

The PA community is incredibly strong and brave, and they all know that their job is to do whatever they can to care for the patients who need them. We will continue to do that. We will continue to be a significant factor in healing our fellow citizens. It’s in our DNA. It’s who we are and what we do.