Thoughts on optimal team practice

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I am writing in my role as president of the Physician Assistant Education Association (PAEA), which represents all of the nation's 226 PA programs and their more than 1,600 primary faculty. I write in reference to “Optimal team practice: Keeping PAs competitive in the marketplace,” by Jeffrey A. Katz, PA-C, DFAAPA, about the proposal by AAPA's Joint Task Force on the Future of PA Practice Authority.
Mr. Katz describes four components of the task force's proposal for what it is calling optimal team practice. The most troublesome component is the second: “elimination of supervisory agreement requirements in law or regulation.” We also share the concerns that have surfaced elsewhere about the methodology and data interpretation used by the task force to reach its conclusions.
PAEA acknowledges the task force's work, which has advanced a strategy to address the changing environment for contemporary PA practice, in which onerous supervision requirements have in some instances produced barriers to practice. And we can support three of the four task force recommendations: team-based practice, creation of autonomous state PA boards, and PA eligibility for direct reimbursement.
However, we believe that the optimal team practice model, as proposed, gives inadequate consideration to the potential consequences for PA education and for patients. Thoughtful consideration needs to be given to preparing PA students for practice in an optimal team practice environment, the effect on new graduates of entering practice without formal physician collaboration, and how the interest of potential applicants to the profession might be affected by changes in the expectation of practice.
The optimal team practice model has been incorporated into a House of Delegates resolution to amend the AAPA's Guidelines for State Regulation of PAs. Despite reassurances from the task force that it is not proposing independent practice, the words it has chosen to amend in the guidelines speak to a practice environment that is not predicated on an existing relationship with a physician (whether formally or informally). The amendments go well beyond the stated goal of “elimination of supervisory agreement requirements in law or regulation.”
We also have concerns about the inclusiveness of the process that the task force employed. Our repeated offers to represent the concerns of PA education on the task force were rebuffed and our involvement was limited to a single meeting with task force representatives in January, at our request. Following that meeting, we established our own task force to examine the issue and develop a report, shortly to be published on the PAEA website.
Clearly, we must find appropriate responses to the changing practice environment. But as we work toward solutions, we must take into consideration the needs of all PA stakeholders, including educators, current students, future students, and patients. Until that occurs, the House of Delegates should not adopt any proposals that would dramatically change the relationship between physicians and PAs. In search of better answers, PAEA suggests that we move forward in the next year to engage productively and collaboratively and that we commit to a four-organization summit on this topic. As organizations, we have responsibilities to each other, to the wider community of PAs, and to patients we serve, to face our challenges together.
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