The recent decision by the Supreme Court to allow Hobby Lobby and other private companies to deny coverage of some contraceptives based on owner’s religious beliefs was swiftly and quickly condemned by key medical and nursing associations.
The American Medical Association, the American Academy of Family Physicians, the American College of Obstetricians and Gynecologists and the American Nurses Association responded immediately when the decision came down, noting that it interferes with the patient-provider relationship and takes decision-making away from the provider-patient partnership. These groups also urged congress to develop remedies to the restricted coverage to help provide access to these services.
Notably absent from the group of medical associations protesting the decision was the American Academy of Physician Assistants.
The AAPA, an association of which I am a member, purports to speak for 100,000 PAs. History will not not be kind to the Academy related to its lack of willingness to speak out on controversial public health issues.
This silence has been demonstrated on numerous occasions, most recently related to its taking a neutral position on the Affordable Care Act, its silence on marriage equality, its reticence to publicly discuss gun safety, and most recently on this issue that will undoubtedly limit access to care for many women.
Academy leadership has long had to tread carefully in the midst of a very politically diverse profession. With its strong military roots, historically (but quickly changing) male-dominated membership, and the diversification of the American population, this is a natural tension.
But other organizations face the same diversity in their organization, yet they time and time again find the will to stand up and speak on public health issues, even when it risks angering some of their own membership.
The AAPA’s mission and vision statement describes an association that is focused on patients (from the AAPA website:
PAs transforming health through patient-centered, team-based medical practice.
AAPA leads the profession and empowers our members to advance their careers and enhance patient health.
- Leadership and Service: We inspire a shared vision to lead the profession, emphasize service to our members and enhance the ability of PAs to serve patients and their communities.
- Unity and Teamwork: We embrace the strength of our members and constituent and partner organizations to speak with one voice for the profession and work together to transform health.
- Accountability and Transparency: We listen, deliver results, take ownership for our actions and operate in an environment of openness and trust.
- Excellence and Equity: We commit to the highest standards and seek to eliminate disparities and barriers to quality healthcare.
It’s hard to see how any organization committed to “the highest standards and seek(ing) to eliminate disparities and barriers to quality healthcare” could stay on the sidelines for public health issues with such monumental impact on fairness, access to care, and equality for patients.
Really, the bottom line is, who does the AAPA exist for? Does it exist to keep its members happy and avoid offending any sensibilities, or does it exist for its patients, the very people for whom PAs were created? Sometimes it’s hard to have it both ways, and wading into the kitchen of being a professional medical association means that it will sometimes be very hot.
It can be argued that medical associations have an ethical obligation to take a stand on public health issues when the evidence indicates that patients will benefit or be harmed. Clearly, in the Hobby Lobby case, patients will be harmed.
So, here’s to the AAPA board and leadership committing to developing a willingness to speak up for our patients, particularly those who are the most vulnerable, and usually the ones with the most at stake in public health controversies such as this one. Because it’s about them, not about us.
Jim Anderson, MPAS, PA-C, ATC, DFAAPA, is founder of Physician Assistants for Health Equity and is a clinician and manager at Evergreen Treatment Services in Seattle.