January, 2017

PAFT Supports FPAR

PAs for Tomorrow (PAFT) is committed to maximizing the benefit of PA services to the public. PAFT unequivocally supports the advances in policy proposed by the AAPA Joint Task Force on PA Practice Authority. We have expressed our commitment to Full Practice Responsibility in our Position Statement published in February 2015. We actively promoted and supported the independent National Task Force on PA Autonomy formed in 2015 to support pursuit of autonomous practice by and for PAs. We contributed to, and actively supported, resolution 2016-A-08 Full Practice Responsibility submitted to the 2016 HOD Congress that led to the AAPA Task Force. With the evolution of healthcare systems and patient care, our profession must also adapt and progress. We must stay relevant in the changing landscape of providing medical care. In short, PAs must govern PAs.

As a profession, we have already agreed to the responsibility and accountability for PA education, as evidenced by the affirmation of 2016-A-07 PA Self Governance and Accountability to the Public. We have chosen to take responsibility for the initial and ongoing education PAs receive as well as initial, and maintenance of, certification. PAs must have the authority, and accept the responsibility, for our profession’s role in increasing access to patient care and the delivery of same. Just as we ensure that we are trained in medical decision making as part of our extensive training in medicine, as a profession, we must have the authority and take the responsibility for eliminating barriers to PAs providing the care for which that training prepares us.

Increasingly, PAs, as a profession, are subjected to governance of professionals – MD/DO and Nursing Administration – that unfortunately don’t have the knowledge of the extent of PA training, both initial and ongoing. This is detrimental to our patients as it frequently creates barriers to care, sometimes inadvertently, sometimes due to ignorance. It is detrimental to our profession when there is underutilization of PAs or limitations on the qualified PAs delivery of care based solely on the skills or training of another individual!  Some of the PAs who have expressed opposition or reservations about FPAR have simultaneously divulged that they are now supervised by the very individuals that they themselves trained. Where is the logic in mandating supervisory agreements there?

We don’t disagree that health care is a team effort. However, the composition of teams varies appropriately to the situation, whether it be primary care or emergency medicine or surgical. ACLS emphasizes the importance of a coordinated team, with individuals taking responsibility for knowing their capabilities and limitations and both acting and communicating accordingly. Every professional that participates on the health care team, making decisions for the best outcomes for our patients, should be fully cognizant of their role and responsibilities and governed appropriately by their profession. All other professions in the delivery of health care take responsibility for the oversight of their professionals; so should PAs.

Supervision or collaboration agreements don’t protect PAs from the consequences of their actions, nor should they. While a newly graduated and certified PA should certainly receive more training, whether it be via a formal residency or on-the-job, PAs know PA education better than any other profession, including MD/DO; PAs should have the responsibility for overseeing the members of their profession and determining when any oversight should no longer be formally or legally required.

Mandatory supervision or collaboration agreements for a qualified PA medical provider jeopardize patient care and waste time. It can also unfairly and unreasonably compromise the PA’s ability to earn a living. The sudden loss of the collaborating physician means an immediate or near-immediate disruption in the care of the PA’s patients as well as their ability to practice medicine. This type of event is becoming more likely in today’s health care environment. In the past, it might have been due to death or incapacitating illness. As more and more physicians are employees and not practice owners, now it is an unfortunate consequence of the termination of employment for whatever reason. Transferring collaboration requirements to another individual still negatively impacts the PA, the patient, and the replacement supervisor. Transferring the patient to another provider disrupts continuity of care for the patient and consumes valuable time from other patients.

The PA name aside, with our current governance structures and our profession perceived as merely an extension to, or assistant of, a physician, be it MD or DO, both private insurance payors and CMS frequently create barriers to practice that negatively impact our patients. We, as a profession, must be recognized for the services we provide and accommodated appropriately in reimbursements and tracking. PAs need increased transparency as a profession and as individuals. The “hidden” value of the work performed by PAs also negatively impacts the profession’s ability to measure the benefits, and the outcomes, of our services.

The PA profession is growing. The composition of the PA workforce is changing. PAs know the PA better than any other profession knows about PAs. The PA profession needs to evolve to adapt to the changes that are happening every day in the world of health care.

PAs need to own the PA Scope of Practice. 

PAs need to self regulate. 

PAs need Full Practice Authority and Responsibility.

Approved by the Board of PAFT

PAs for Tomorrow is a  professional organization for all PAs of all specialties.  It represents the future interests of all PAs, providing a vocal core group of PAs committed to seeing the PA profession reach its deserved place among America's health care providers and advocating for their role as providers of high-quality, cost-effective, comprehensive and patient-centered health care. 

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