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State Corner – PAs Move to Eliminate Physician Supervisory Relationship Laws

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State Corner – PAs Move to Eliminate Physician Supervisory Relationship Laws

The American Academy of Physician Assistants (AAPA) approved a policy in May seeking to remove state regulations that “require a physician assistant (PA) to have and/or report a supervisory, collaborating, or other specific relationship with a physician ... [and seeking to establish] autonomous state boards with a majority of PAs as voting members to license, regulate and discipline PAs, or for PAs to be full voting members of medical boards.” With this move, AAPA is moving forward with its push to eliminate the formal supervisory relationship between physicians and PAs.

The move provoked strong opposition from the American Medical Association (AMA) House of Delegates in June. An AMA committee report labeled this as “anticipated legislation to move PAs into a more autonomous role” since state medical boards currently have authority over PAs.

AAPA is branding the effort as “Optimal Team Practice” with an overarching goal of removal of state 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. In addition, the new policy advocates for the establishment of autonomous state boards with a majority of PAs as voting members to license, regulate, and discipline PAs, or for PAs to be full voting members of medical boards. Finally, the policy says that PAs should be eligible to be reimbursed directly by public and private insurance for the care they provide. According to AAPA, “Optimal Team Practice” resembles, but is not the same as, full practice authority, which nurse practitioners have been pursuing.

Steven J. Stack, President of the AMA, disagreed with AAPA’s notion of “Optimal Team Practice.” Dr. Stack said, “their professional societies’ push for enhanced autonomy flies in the face of everything in the modern era that supports team-based care. It’s all well and good to say that they’re part of a team, but some are pushing to go out and hold themselves as independent, and that is inconsistent with all of the current thinking about the value of team-based care, of which physicians are a part and from whose participation all of them benefit.”

Several PAs have publicly opposed the move by AAPA for independent practice and have questioned the potential harm of the policy to the overall profession. Jim Anderson, MPAS, PA-C, DFAAPA, a physician assistant in Seattle, wrote in Clinical Advisor, “[AAPA] have long argued for independent practice, and their message has never resonated with me. I've always seen the physician assistant's long history of close connection with physicians as being what sets us apart from our ‘independent’ nurse practitioner (NP) colleagues.”

Several states have already seen legislation to create a “Doctor of Medical Science (DMS)” advanced degree for PAs. According to analysis of these proposed laws, DMS would be essentially held as equivalent to a physician or dentist in state law. Lincoln Memorial Univeristy’s DeBusk College of Osteopathic Medicine and Lynchburg College have instituted a DMS degree program.

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