Barriers to PA recruitment continue to exist as a result of statutory requirements. In today’s health care system, physicians are more likely to be employed by a large institution. Because of this, they may no longer see a financial benefit to entering into a formal agreement with a PA, which is currently required by statute for PAs to practice. Furthermore, as PAs and physicians increasingly practice in groups, the requirement for PAs to have an agreement with a specific physician is challenging to manage and places all providers involved at risk for disciplinary action for administrative infractions unrelated to patient care or outcomes.
Advocates for OTP also emphasize the perception that our NP colleagues are preferentially hired over PAs. In 22 states and the District of Columbia, NPs are allowed to practice without a collaborative agreement with a specific physician, anecdotally making them easier to hire.4 Even in states where NPs do not have FPA, the perception that hiring an NP is less burdensome than hiring a PA often exists. If accurate, these reports suggest PAs are at a disadvantage relative to NPs, resulting in lost opportunities for employment and advancement. (At least one study—based on a survey of members of the American College of Emergency Physicians council, who have direct experience in hiring NPs and PAs—demonstrated no differences in hiring preferences between the two professions. The same survey also revealed wide variability in supervisory requirements, however.5)
By recommending the elimination of the requirement for PAs to have an agreement with a specific physician in order to practice, AAPA is in effect broadening an evolution already occurring at the state level. In 2016, Michigan removed the supervisory requirement and repealed the stipulation of physician responsibility for PA-provided care; PAs in Michigan now practice with a “participating physician.” In 2017, New Mexico amended its Medical Practice Act to allow PAs who practice primary care to collaborate with a physician, while PAs who practice specialty care must be supervised by a physician.6 Illinois recently signed a 10-year extension of the state’s PA Practice Act that also better reflects the relationship between PAs and physicians, substituting “collaborating physician” for “supervising physician.”7 West Virginia has also adopted legislation referring to the physician/PA relationship as a “collaboration” (terminology Alaska has used since the 1980s).
In supporting the recent changes in Illinois, Dr. Nestor Ramirez, President of the Illinois State Medical Society, noted that “Patients are best served by physician-led teams of professionals practicing within the scope of their licensure, and physicians work collaboratively with PAs and other allied healthcare professionals to ensure that the care provided is of the highest quality.” Changing the terminology to collaboration, he added, simply “brings the language of the Physician Assistant Practice Act in line with that of other licensure acts.”7
Perhaps the larger challenge in implementing OTP will be achieving this level of support from all our physician colleagues. In a small survey on this topic conducted by researchers at the Hofstra Northwell School of Graduate Nursing and Physician Assistant Studies, nearly 80% of physician respondents had no previous knowledge of OTP. The majority (62.8%) agreed with the notion that PAs are committed to team practice (first component of OTP); however, less than half of the respondents (47.3%) said they would support OTP policy. The authors concluded that OTP advocacy efforts should target physician awareness and support.8
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