Optimal team practice: Questions remain

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Optimal team practice is the newest name for a political movement underway in the PA profession that heretofore has been termed FPAR. The AAPA has made attainment of optimal team practice a high priority and last fall formed the Joint Task Force on the Future of PA Practice Authority. The task force issued a preliminary report that suggested that attaining optimal team practice would result in a wider variety and greater number of jobs for PAs, more flexibility in those positions, less paperwork burden, and more availability for PAs to care for their patients.1
The report asserted that, with optimal team practice, PAs would practice as members of healthcare teams that include other PAs, physicians, NPs, nurses, pharmacists, physical therapists, and social workers; would be able to practice to the top of their individual education, training, experience and competency; would recognize the limits of their knowledge and skills; would know when a patient's condition requires consultation with and/or referral to other qualified healthcare providers; and accept liability for the care they provide. The task force also recommended establishing autonomous state boards consisting of a majority of PAs; these boards would license, regulate, and discipline PAs. PAs also would be eligible to be reimbursed directly by public and private insurance.1
The task force and the report came under sharp criticism by various individuals and PA groups that noted the lack of evidence to support the claims as well as the overly rosy picture painted if optimal team practice was attained. Some observers noted a lack of objectivity about the outcomes of such proposed legislative and scope-of-practice changes. One state chapter stated that there was insufficient information for PAs to make an informed decision, that there was a lack of supporting evidence for the task force's claims, and that these issues would bring into question the validity of the FPAR survey. The chapter stated that it was “deeply concerned about the lack of objectivity and due diligence on the part of the Board and the Task Force as evidenced by the failure to provide any findings or analysis of legal, regulatory, or policy issues that may conflict with FPAR.”2
In an article in this issue of JAAPA (“Optimal team practice: Keeping PAs competitive in the marketplace,” at www.jaapa.com), the task force's chair acknowledges the input that the task force has received but steadfastly maintains that attaining optimal team practice would allow more time for patients and greater access to care. In addition, PAs are facing increasingly competitive healthcare market forces. Among other advantages, PAs would:
The AAPA asked its research division to conduct a national opinion survey on optimal team practice. The survey was fielded from January 12 through February 1, 2017; was sent by e-mail to 102,101 PAs, retired PAs, and PA students for whom AAPA had valid e-mail addresses; and attained a response rate of 12.6% (12,485 respondents) and a margin of error of 0.83% at the 95% confidence level. A majority of survey respondents (71%) expressed overall support for the task force proposal, with 13% opposed and 16% undecided. Respondents expressed support for a continued commitment to team-based practice (96%) and for ensuring that PAs are eligible to be reimbursed directly by public and private insurance (93%). Most (79%) of respondents said they supported establishing autonomous state boards, with a voting membership composed of a majority of PAs, to license, regulate, and discipline PAs.
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