Navigating the Waters of Independently Practicing Physician Assistants

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There have been several efforts to put more space between PAs and MDs, including several efforts to have the AAPA endorse a different title.
There have been several efforts to put more space between PAs and MDs, including several efforts to have the AAPA endorse a different title.

Physician Assistants (PAs) have been around for about 50 years, after being birthed by the midwives of the profession, also known as MDs. We PAs have always had a close and formal connection to MDs, which has made us unique in the medical world.

Over the years, there have been several efforts to put a little more space between PAs and MDs, including several efforts to have our professional association, the American Academy of Physician Assistants (AAPA), endorse a different title. Many PAs, young and old alike, have chafed under the word “assistant,” often feeling that this misrepresents and belittles our profession and the work we do.

In my experience as a PA, I've never shared that concern. I've always felt that our connection to MDs is one of our strengths, setting us apart from our “mid-level” colleagues in other professions. And up until recently, this has been the stance of the AAPA. Efforts to pass resolutions calling for a name-change in the AAPA House of Delegates have repeatedly failed.

Still, inroads have been made by the advocates for increased autonomy. They have been effective political strategists, and have made significant gains in garnering and organizing support for their vision of PAs practicing without a requirement to have a formal connection with an MD. To me, that's independent practice, and it's something many MDs and MD associations such as the AMA have worried about since the inception of PAs. And up until recently, their worries have been ill-founded.

But recently two developments have some MD colleagues very concerned. An organization representing the effort to move toward autonomy has made big inroads into the AAPA, resulting in a push toward unhitching ourselves from our MD colleagues. First came the decision by the AAPA to propose that we stop saying “physician assistant,” and to “just say PA.”  This has clearly been a result of the inroads of the name-change, independent practice proponents.

Second came the success of a resolution at last year's AAPA House of Delegates, supporting the adoption of a concept originally called “Full-Practice and Responsibility,” later changed to the more catchy “Optimal Team Practice.” For many MDs, the sticking points of both is this statement, from the Full Practice document on the AAPA site:

  • 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 majority PAs, to license, regulate, and discipline PAs.

My guess is that changing the name to “Optimal Team Practice” was an attempt to de-emphasize the independent practice component. OTP proponents will quickly move to a talking point which underscores the belief that team-based care is superior, etc. But this doesn't appear to be placating MDs and MD organizations who are extremely concerned about this effort. The AMA is creating resources for state associations to oppose the OTP effort, particularly as it comes up in individual states. And many PA chapters and individuals are reporting strong push-back from their MD colleagues, with some noting concerns that the OTP effort by PAs has the potential to undermine the strong PA-MD partnerships that have been developed over the last 50 years.  

It's important to note that creating AAPA policy does little to implement any new concept. Instead, it is simply a statement of philosophy of the PA professional association. While it is an important statement to the medical community, such uncoupling of PAs and MDs can only happen in individual state legislations, something that remains a formidable obstacle for those proposing this change in physician assistant practice.

Reference

Lane S. From physician assistant to PA. American Academy of PAs. 2016. Accessible at: https://www.aapa.org/career-central/physician-assistant-pa/

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