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AAPA Special Article

Progress toward modernizing the PA profession

Sobel, Jonathan E. DMSc, MBA, PA-C, DFAAPA, FAPACVS

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Journal of the American Academy of Physician Assistants: December 2018 - Volume 31 - Issue 12 - p 42
doi: 10.1097/01.JAA.0000547751.38676.f8
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In 2019, it is increasingly likely that legislation will be introduced in several states across the country to adopt one or more elements of optimal team practice (OTP). This will mark tremendous progress toward achieving the vision for the PA profession set forth by the American Academy of PAs' (AAPA's) House of Delegates in May 2017.

As the old saying goes, timing isn't everything—it's the only thing. OTP addresses two significant issues that are top of mind for legislators in 2019: increasing patient access to care and controlling healthcare costs.

Although every element of AAPA's Guidelines for the State Regulation of PAs and our Model State Legislation for PAs is important, perhaps the most significant is removing the legal requirement for PAs to have an agreement with a specific physician in order to practice. Like every other healthcare professional, PAs should be able to be responsible for their practice decisions. Tying PAs to a specific physician is administratively burdensome, archaic, and is simply not necessary. Removing this requirement will help strengthen healthcare teams by putting decisions about scope of practice where they belong: at the practice level. State laws should not dictate to healthcare teams how many PAs a physician can collaborate with or which medical charts should be cosigned. Those decisions should be made where the care is being provided.

In fact, a June 2018 study conducted by the Hamilton Project, an economic research group and think tank within the Brookings Institution, concluded that removing barriers to PA practice, like unnecessary agreements between a PA and a specific physician, would help alleviate healthcare shortages and improve efficiency and productivity in the delivery of healthcare—all with no adverse reactions on patient outcomes.1 Talk about timing!

Removing the legal tether of the PA acting as an agent of the physician does not diminish PAs' commitment to team-based care, nor does it represent a desire by PAs to practice independently. In fact, no healthcare profession practices in a vacuum; all consult and collaborate. Rather, it will represent the maturation of the PA profession to actually be responsible for the care we provide. It will expand access to care for patients by removing barriers that might keep them from having access to PAs. Physicians will be able to continue working in teams with PAs without being vicariously liable for decisions that the PAs make.

Eliminating this unfair administrative burden will also put us on an equal footing with our NP colleagues when it comes to employment. At present, NPs in 22 states and the District of Columbia are not required to have an agreement with a specific physician to practice.2 This reduces the administrative burden imposed on employers, physicians, and NPs, not only when NPs are hired but also when they change departments or locations. Even in states that still require this legal tether for NPs, the perception that they are easier to hire and manage permeates employer decision-making.

For example, a PA in Florida was turned down for a job and was told that an advanced practice registered nurse (APRN) was hired instead. When he asked why, the recruiter noted that the APRN could work without supervision by a physician. This is not the case for Florida APRNs but was the employer's perception.

Although enactment of PA modernization legislation would be ideal, even the introduction of it in state legislatures would represent incremental progress for our profession, bringing awareness to the problem and paving the way for success in upcoming legislatures. I commend the leadership of AAPA's constituent organizations for embarking on a journey fraught with challenges but rich with potential rewards, especially for patients and for our healthcare system.

Legislative change will not be fast or easy. But PAs know that it is work we must do—for our profession and for our patients.


1. Adams K, Markowitz S. Policy proposal: improving efficiency in the health-care system: removing anticompetitive barriers for advanced practice registered nurses and physician assistants. Washington, DC, Hamilton Project, 2018.
2. American Association of Nurse Practitioners. State practice environment. Accessed September 10, 2018.
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