Optimal team practice: How to get there
This commentary is a requested response to the June online article “Optimal team practice: Keeping PAs competitive in the marketplace,” by Jeffrey A. Katz, PA-C, DFAAPA, and subsequent discussion in the American Academy of PAs (AAPA) House of Delegates meeting at the AAPA conference in May 2017. At the conference, an amended version of the Joint Task Force proposal was accepted by the House of Delegates.1 I have always been in favor of optimal team practice and full-practice authority and responsibility. Both concepts have been at the core of the PA profession since the first class was admitted to Duke University's PA program in 1965. The authority for PA practice was granted by the supervising physician and varied depending on the physician's scope of practice. As founder Eugene Stead, MD, pointed out, this approach fostered great flexibility and growth for PAs and their joint practice.2 Eugene Schneller, a noted medical sociologist who studied PA practice in the 1970s, was impressed with the “functional autonomy” that PAs enjoyed within the physician supervisory framework.3 Clearly, PAs who have been in practice for 10 or 20 years are more capable than they were as newly minted PAs.4 AAPA's Guidelines for State Regulation of PA Practice address this reality in several creative ways.5
The AAPA also has produced model state legislation, first adopted in 1991 and updated periodically since.6 Although there has been strong AAPA advocacy for shifting from physician supervision requirements to collaboration with physicians, the AAPA Joint Task Force, chaired by Mr. Katz, argued for removing the requirement for physician collaboration, altogether. Fortunately, this language was amended as cited above, after heated debate in the House of Delegates at the May 2017 conference. It is noteworthy that the 24-member Joint Task Force contained only PAs. This hardly represents collaboration, and sends the wrong message to those outside of the PA profession. Discussion of these and related issues also must be carried out among the four PA organizations in a rigorous and respectful manner.