I propose several criteria as a starting point for PA autonomy discussions.11 PAs should
• Be NCCPA board-certified and eligible for state licensure
• Have three years full-time, or 6,000 hours, of practice in a primary care setting
• Have practiced at least one of the three required years within the previous two calendar years.
As I see it, PAs in a state that has passed full practice authority legislation, and met the above criteria, could start practicing without collaboration as soon as the law takes effect. Out-of-state PAs applying for licensure in a state with autonomy legislation should be permitted to use their practice experience in another state to meet the minimum requirements for autonomy.
The time has come to remove punitive legislation and supervisory burdens from hard-working, well-intentioned, quality providers. Many physicians practicing on the front lines of medicine with PAs and NPs are choosing to hire NPs who are independent, because it’s easier for them to do so. Independent NPs do not come burdened with a state-mandated list of supervisory requirements (which may create a perception of increased legal liability for the physician).
Many PAs may fear backlash from physicians over the issue of autonomy. The reality is that, yes, there will be some resistance from organized medicine. But when PA autonomy legislation is passed, organizations and physicians will continue to hire PAs—just as they continue to hire NPs. PAs who gain autonomy will be studied just as independent NPs are being studied. And, as is the case with our NP colleagues, PAs’ patient outcome data will continue to be positive.
Laws are not what make good providers. Accredited education programs, quality CME, access to technology, best practices, and team health care make good providers. America doesn’t have 20 years to wait for PAs and NPs to creep forward with baby steps in legislative sessions that last years. Our patients need us now! They need PAs and NPs to fight for their care, to be their advocates, and to be their providers.11 They need us to stand up and own our professions so we can be more effective—not for us, but for them. I hope you agree. Feel free to send your thoughts to PAEditor@frontlinemedcom.com.
REFERENCES
1. United Health Foundation. America’s Health Rankings: a Call to Action for Individuals and Their Communities (2014). http://cdnfiles.americashealthrankings.org/SiteFiles/PressReleases/Americas%20Health%20Rankings%202014%20Edition.pdf. Accessed September 9, 2015.
2. Association of American Medical Colleges Center for Workforce Studies. 2013 State Physician Workforce Data Book. https://members.aamc.org/eweb/upload/State%20Physician%20Workforce%20Data%20Book%202013%20(PDF).pdf. Accessed September 9, 2015.
3. Physician Assistant Education Association. PAEA 28th Annual Report: Physician Assistant Educational Programs in the United States, 2011-2012. www.paeaonline.org/index.php?ht=a/GetDocumentAction/i/156969. Accessed September 9, 2015.
4. Hooker RS, Nicholson JG, Le T. Does the employment of physician assistants and nurse practitioners increase liability? J Med Licensure Discipline. 2009;95(2):6-15.
5. Hooker RS, Muchow AN. Modifying state laws for NPs and PAs can reduce cost of medical services. Nurs Econ. 2015;33(2):88-94.
6. Isaacs S, Jellinek P. Accept No Substitute: A Report on Scope of Practice. The Physicians Foundation. November 2012: 14-15. www.sc.edu/study/colleges_schools/nursing/centers_institutes/center_nursing_leadership/sc_onevoice_oneplan/a_report_on_scope_of_practice.pdf. Accessed September 9, 2015.
7. American Association of Nurse Practitioners. State Practice Environment. www.aanp.org/legislation-regulation/state-legislation/state-practice-environment. Accessed September 9, 2015.
8. LeBuhn R, Swankin DA. Reforming Scopes of Practice: A White Paper. Citizen Advocacy Center. July 2010. www.cacenter.org/files/ReformingScopesofPractice-WhitePaper.pdf. Accessed September 9, 2015.
9. Department of Veteran’s Affairs, Veteran’s Health Administration. VHA DIRECTIVE 1063: Utilization of Physician Assistants, Appendix A-5. www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2958. Accessed September 9, 2015.
10. Federal Trade Commission Office of Policy Planning, Bureau of Economics, and Bureau of Competition. Letter to Representative Kirkton, April 21, 2015. www.ftc.gov/system/files/documents/advocacy_documents/ftc-staff-comment-representative-jeanne-kirkton-missouri-house-representatives-regarding-competitive/150422missourihouse.pdf. Accessed September 9, 2015.
11. Sady B. Optional Autonomy for PAs in Nevada: A White Paper. June 2015. https://app.box.com/s/6f6567b1fobkvvo1g7egfd2gq6ir1jx7. Accessed September 10, 2015.