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Becoming a PA

I am just a bill, stuck on Capitol Hill

Gilpen, Johnnie L. Jr. MS

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Journal of the American Academy of Physician Assistants: March 2019 - Volume 32 - Issue 3 - p 1-2
doi: 10.1097/01.JAA.0000553388.05755.41
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Throughout most of my military service and subsequent career as a disaster response epidemiologist, I focused on “boots on the ground” objectives and strategies. Seldom did I have what I consider the luxury of a 30,000-ft view. As a 47-year-old first-year PA student, I've found that nothing has changed, except I'm not nearly as smart as I thought I was. When the PA faculty suggested I run for a class officer position, I thought this might be an opportunity for me to go beyond my comfort zone. After I researched the roles and responsibilities of the various positions, I did not feel that any of the positions would be a good fit for me to develop and grow as a leader. Then an upperclassman suggested I look at running for one of the student delegate positions with the AAPA House of Delegates (HOD). He said it would be an amazing opportunity to learn about PA-related advocacy. I thought, why not?

In September 2017, I was one of 21 PA students elected from across the nation to represent, in the HOD, the more than 14,000 students enrolled in PA programs in the United States. Students compose about one-third of the total AAPA membership and are the largest voting delegation in the HOD. Mia McDonald, chief delegate and Student Academy of AAPA board member, recommended that as a newly elected delegate, I attend the AAPA's annual Leadership and Advocacy Summit (LAS) in Arlington, Va., in March 2018.

The objective of the 3-day LAS is to promote grassroots advocacy for constituent-based organizations at the local, regional, and national level. This experience was my first real introduction to legislative processes. Day 1 was dedicated to mechanisms and procedures associated with the development or amendment of new PA-related federal policy. The focus was on the congressional legislative processes of bringing a bill to law. Ironically, I found myself singing the old Schoolhouse Rock song from my childhood Saturday morning cartoons: “I'm just a bill, stuck. Yes, I'm only a bill. And I'm sitting here on Capitol Hill.”

Summit activities focused on promoting legislation to reduce barriers to PA practice. The morning session used the Medicare Patient Access to Hospice Act of 2017, House Resolution 1284, as a working example. HR 1284 provided a current and relevant example of how grassroots advocacy can bring new laws to fruition, providing an indepth, step-by-step approach for amending current Centers for Medicare and Medicaid Services (CMS) regulations. HR 1284 amended CMS regulations allowing PAs the ability to provide hospice-specific medical services.

In the afternoon, participants teamed up with PAs from their respective state chapters to meet with their US Representatives and Senators to promote the passage of HR 1617, the Promoting Access to Diabetic Shoes Act. Under current CMS regulations, PAs are authorized to provide all aspects of care for patients with diabetes except prescribing diabetic shoes. For Medicare and Medicaid patients to receive these shoes, they must be referred to a physician, which includes the transfer of all associated diabetes-related care to that physician—a loss for the PA. Advocating for the passage of HR 1617 afforded me a unique, eye-opening experience on the depth of investment needed to put an idea into law.

The second and third days focused on leadership training for constituent organizations. Speakers discussed the importance of not only being a member of your state PA association but also taking an active role in the organization. I developed a better understanding of how state chapters can bring about positive change for the PA profession. It is the grassroots effort that ultimately helps bring state legislation in line with the current professional standard. My takeaway is that the work of improving and changing laws that affect how I eventually will practice as a PA cannot be left to others. I have to become actively involved and work to mold my profession.

I did not fully grasp the processes I was exposed to at LAS until I began working on our student delegation resolutions for the 2018 AAPA conference in New Orleans, La. Between the LAS in March and the HOD meetings in May, student delegates worked diligently to develop and bring forth two resolutions. The first, 2018-C-13-SAAAPA Increasing PA Diversity, sought AAPA support for initiatives associated with increased funding for development and operation for historically black colleges and universities (HBCUs) and Hispanic-serving institutions (HSIs). During the meeting, the resolution passed with minimal discussion; our second resolution, however, was a different story. 2018-C-14-SAAAPA Support for PA Student Federal Loan Limits urged the AAPA to support initiatives increasing federal loan limits to provide parity with loan limits available to other healthcare professional students. Several delegates voiced concerns that if limits for federally subsidized loans for PAs were increased to parallel that of physicians, NPs, and others, a school may be inclined to raise tuition rates. Student delegates countered not only with statistical and factual evidence but with personal stories. Ultimately, in the end, I am very proud to say the HOD adopted both resolutions.

At the end of the HOD meeting, I found I had enjoyed engaging in the grassroots efforts to mold my profession. Because of the encouragement I received from fellow delegates, I will apply to be a student delegate to the 2019 HOD, continuing my path of PA advocacy. I believe I will be able to use these experiences to promote other interests I have, such as advocating for veterans' issues and prehospital and disaster response. LAS provided me the opportunity to acquire the knowledge and skills to be an educated voting delegate in the policymaking body of the AAPA.

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