FPAR and labor complexities
Labor movements are not new; Karl Marx described the history of “socially inferior” groups seeking independence from elites in the mid-1800s.1 This labor movement seems to be based on a number of PAs who would like to emulate the growing independence of NP scopes of practice.2 One argument is that PAs want to be architects of their own destiny. Unlike PAs in the Netherlands, where the central government decided each profession should be self-regulated, PA independence in the United States seems to be part of a grassroots effort that will involve changing regulations in 56 independent jurisdictions.3
In general, labor movements are influenced by two factors: the forces shaping the behavior from within, and the intended economic consequences of united cause behavior. Because this effort is taking shape in a capitalist market, the effect of price mechanisms helps define the underlying reason.1 One economic question is: Will FPAR make a difference in compensation if PAs are independent practitioners? In my view, FPAR's advantages and disadvantages remain to be fleshed out in the public domain. Some of the potential advantages and disadvantages that come to mind include:
The ability to be the master of your own employment destiny is an embedded theme in labor history and the human spirit. At the same time, equilibrium in US medical practitioner supply and demand is looming and PA jobs are predicted to be less plentiful in a few years.4-6 If improved compensation is at the heart of this independence movement, an earnest thought for some, such goals might help to justify the effort. A belief that NPs have a hiring preference over PAs because of regulation independence is another reason for change in scope of practice.7 However, as of 2017, very few PAs and NPs are independently employed; most work for an organization.8 On the other hand, the overregulation of PAs and NPs offers little benefit to society and less regulation probably would be better.9
Independent reimbursement is another noble idea—direct remuneration for one's own work. Comparable worth for similar outcomes may be at the heart of this line of thinking. However, third-party payers have resisted reimbursing more and more groups, as is the case with physical therapists, NPs, and certified registered nurse anesthetists. Furthermore, reimbursement may not be at the same level as physicians even when the outcomes are the same. The theory of human capital says that when the stock of knowledge, habits, and social and personality attributes are embodied in the ability to perform skilled labor, the reward will be at a higher economic value than that for someone with less education. This influenced why Medicare and Medicaid reimburse PAs and NPs at 85% of the prevailing physician rate for comparable services.
Although the list of advantages and disadvantages to FPAR is far from complete, I suggest these and other factors could contribute to a richer discussion than the arguments raised to date. Enjoined labor is a complex and mixed subject that tends to draw polarized views. The efforts of united movements are not all good and certainly not all bad, but often arise as a means to improve status, working conditions, or compensation. However, sometimes the desire for gain minimizes future risk and occasionally organizations end up replacing the lot of united workers with outsourced contracts. And sometimes mechanization replaces everyone.