Forty years after the establishment of their professions, PAs and NPs can look back with pride at the advances they have made. Yet each year, on both state and national levels, new legislation is proposed that will impact—for better or worse—their ability to provide high-quality patient care.
Staying on top of the issues can be a full-time job, and the one thing practicing clinicians never seem to have is enough time. It leaves many to wonder, “Can’t someone else take care of those details?”
Therein lies folly, say leaders from both the American Academy of Nurse Practitioners (AANP) and the American Academy of Physician Assistants (AAPA). “If you don’t participate, then you are at the mercy of those who choose to,” says Ann Davis, PA-C, Director of State Government Affairs for AAPA. “And they may not make decisions that you like.”
Furthermore, clinicians’ livelihoods depend on the policy decisions of local, state, and federal governments. The bottom line, according to Jan Towers, PhD, NP-C, CRNP, FAANP, Director of Health Policy for AANP, is “you’re not going to keep your ‘real’ job if you don’t have laws and regulations and policies that allow us to function.”
A Matter of Priorities
Lest anyone suspect Towers is exaggerating, a case in point: Last year, the PA Practice Act in Illinois—which, in a nutshell, gives PAs the right to practice in the state—was due for renewal. The Illinois Academy of Physician Assistants (IAPA) set to work at the start of 2007, contacting other organizations and state departments to iron out any potential areas of conflict in advance; the organization purposely avoided any controversial requests in SB149. In March, the bill made it through the Senate without difficulty and moved to the House.
However, in a crowded legislative session, the bill languished there—and the addition of five separate amendments further delayed its progress. (Each time an amendment is proposed, a bill must go back to committee for review and approval.) Salvation came only when a senator added the renewal of the PA Practice Act (along with those of many other professions) to HB1284, which had passed in the House and was under consideration by the Senate. Thanks to the persistent efforts of IAPA and many individual PAs, the bill zipped through three committees in one day, was placed on the agenda, and passed on November 2.
“Could it have happened without everybody calling? Maybe,” says IAPA President Sherie Turner, PA-C. “But we’ve never seen anything happen that rapidly before.”
Turner was informed by her local representative that “there was so much pending legislation in Illinois at the end of the year that our bill could certainly have gotten lost.” [After another nail-biting wait, Gov. Rod Blagojevich signed the bill into law on December 31—just in time.]
While opposition to a bill is perhaps a more obvious cause for concern, matters of priority are increasingly common. “Our issues, on the scale of things like a trillion-dollar budget, are relatively small, so it’s hard to get them to rise to the surface unless there’s a lot of push from the constituencies,” Towers observes.
This emphasizes the importance of PAs and NPs—collectively and individually—to the success of a legislative initiative.
If You Don’t, Who Will?
Turner understands the complacency that many feel when it comes to politics. “I can tell you I didn’t do anything much legislatively, or actively contact my representatives, before I was in this position and felt it was my responsibility,” she admits.
There are things that every clinician can do, “even when you have newborn twins with colic and your hair is on fire,” as AAPA’s Davis says. She adds that everyone should “become involved personally in the political process, to whatever extent you are able.”
Political activism can range from putting up a yard sign in support of a candidate at election time or occasionally attending a forum at which candidates discuss issues, to hosting a fundraiser or contributing to a political action committee “that is aligned with your interests or the interests of patients,” Davis says. Staying on top of issues related to clinical practice or other aspects of patient care is as easy as reading the newspaper, surfing the Internet, or staying in contact with your state professional organization.
“Every state is its own little country,” Davis says. “That’s the really great thing about having state chapters—those folks know what works here, who you can talk to.”
Yet, state professional organizations struggle with membership. The financial support from membership dues can enable a group to establish an office and have a full-time director who can monitor legislative and regulatory issues. More fiscally solvent professional groups can afford to have full-time lobbyists.