Optimal team practice: Much at stake

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It was inevitable that we would arrive at this moment along the arc of our profession's existence. The world is changing and appropriately our leadership has shepherded our attentions and energies to understanding how best physician assistants (PAs) should adapt. The June online commentary, “Optimal team practice: Keeping PAs competitive in the marketplace,” by Jeffrey A. Katz, PA-C, DFAAPA, on the work of the AAPA Joint Task Force on the Future of PA Practice Authority provides a wonderful background and foreground on the issue of optimal team practice, establishing a solid foundation from which we can all meaningfully participate in our organization's decision-making process. His leadership and the devotion of the task force to this cause is to be commended.
Although pursuing optimal team practice is less likely to draw the sort of ire that full practice authority and responsibility (FPAR) will, PAs must steel themselves for what could be a fight unlike any other in our experience. Much is at risk for stakeholders both internally and externally no matter how our chosen approach is couched. Mud will be slung, names will be called, and calculated sacrifices inclusive of longstanding interprofessional relationships, intraprofessional harmony, and hard-earned political capital will be offered up. At its extreme, our reputation may tarnish.
But that's how the hardest battles are won. If it is our collective will to engage this agenda, it cannot be a half-hearted measure supported by a well-researched policy paper. We must be all-in with action to support our words. We must be willing to spend our organizations and its members' treasure, measured in all of its different units of value and inclusive of dollars that we would have spent on other competing priorities. For those reasons, it is our responsibility to be as informed as possible before giving our collective green light to proceeding.
We must consider that optimal team practice may not satisfy the independent practice faction of our ranks who desire unfettered autonomy and greater control over their own professional destiny. We must consider how it will cause our physician colleagues to react. We count on physicians' support against what arguably has been perceived by them to be the greatest siege on the medical profession through the passage of advanced practice RN (APRN) legislation. Finally, we cannot ignore the threats to our own flank posed by the fractious issue of national certification and the growing rift between the National Commission on Certification of Physician Assistants and the American Academy of PAs (AAPA). This point alone and the potential costs outlined at AAPA's Leadership and Advocacy Summit should give one pause as we discuss the specter of fighting two wars concurrently.
In the middle are those of us who want to strike a balance between where the profession needs to go and the allocation of that treasure and premium resources to make the journey successful. In this debate, I have observed that as a profession that relies on science and evidence (tools that transcend the impassioned discourse of perception and opinion), we have uncharacteristically been glad to accept the absence of the same in our discourse on this issue. Instead we have been content to rely on nonspecific experiences and surveys as a surrogate for the compelling proof we would otherwise demand to inform our patient care decisions.
Why accept a lesser standard when so much is at stake? It is a fact that FPAR for APRNs is the law in more than 20 states, so surely a wealth of facts has developed around the APRN legislative and practice experience that can answer many critical questions.
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