As the American Academy of Physician Assistants (AAPA) is moving forward with its push to eliminate the formal supervisory relationship between physicians and PAs (see the AAPA web page about the Joint Task Force on the Future of PA Practice Authority), I grow more worried about the peril of this effort. This action is related to the continuing debate related to our official title “Physician Assistant.”  It also indicates the success of the well-organized AAPA special interest group “PAs for Tomorrow.” This is a movement that has grown significantly over the last few years, as evidenced by the election of one of their key players to the AAPA Board of Directors.

They’ve long argued for independent practice, and their message has never resonated with me. I’ve always seen the physician assistant’s long history of close connection with physicians as being what sets us apart from our “independent” nurse practitioner (NP) colleagues. 

But we needn’t re-litigate all the old and somewhat worn points in the long discussion about the advisability of trying to keep up with the NP profession. There’s not much new to say about that.

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Instead, I am concerned about the way this effort is building on the national and state level, because there appears to be a very giant elephant in the room: failure to include our MD colleagues in this discussion. In the communications I read from the AAPA and others who favor
Full Practice Authority and Responsibility, I almost never see any mention of including our MD colleagues in the conversation, and I think there is great peril in this omission.

Such an effort as this will require the support of the MD profession, period. And the time to get that support is now, not later. We all know that many of our MD colleagues, and at least a significant portion of the organized MD world, will feel very nervous about this effort. We need to have open conversation with them from the beginning.

Maybe that conversation is happening, but I sure don’t see it. If it is, please educate me about it. Not doing so now has the potential to confirm what many MDs have suspected for years—that what PAs have really wanted all along is to jilt our MDs and go into independent practice. And while that may have been the goal for many PAs, it has never been mine. MDs birthed PAs, and I think there is great value in having a formal connection with them. But even if I am in the minority on this (which I don’t think is true, as evidenced by the AAPA’s repeated rejection of related proposals in the House of Delegates), any chance to succeed in such an effort is destined to fail without the inclusion of MD colleagues in the conversation.

Here’s a brief summary from the AAPA about the principles of the Full Practice and Authority concept, from the Joint Task Force on the Future of PA Practice Authority:

The Joint Task Force believes that AAPA policy should:

  • Emphasize the PA profession‘s continued commitment to team-based practice
  • Support the elimination of provisions in laws and regulations that require a PA to have and/or report a supervisory, collaborating or other specific relationship with a physician in order to practice
  • Advocate for the establishment of autonomous state boards, with a voting membership comprised of a PA majority, to license, regulate, and discipline PAs
  • Ensure that PAs are eligible to be reimbursed directly by public and private insurance

It’s not too late to address the omission of MDs in the discussion, and I hope that PAs who advocate for this change and the powers-that-be in the AAPA will do so with great haste.

Jim Anderson, MPAS, PA-C, DFAAPA, is a physician assistant in Seattle. 


  1.  American Academy of Physician Assistants. Joint Task Force on the Future of PA Practice. Published November 14, 2016. Accessed January 23, 2017.