Breaking Barriers: Advocating for PA-C Rights in the US Healthcare System
Advancing PA Autonomous Practice Rights for a Stronger Healthcare System
Table of Contents
· A Hot Topic: Physician Assistant Autonomous Practice Rights
· What is a Physician Assistant?
· Why are Physician Autonomous Rights Needed?
· Can Physician Assistants Practice Autonomously?
· What is the Corporate Practice of Medicine?
· Understanding the Fight Against Physician Assistant Autonomous Practice
· PAs vs Doctors
· 5 Ways to Advocate for Physician Assistant Autonomous Practice Rights
· Final Thoughts
· Connect
A Hot Topic: Physician Assistant Autonomous Practice Rights
Physician Assistant (PA) autonomous practice rights are remarkably contested in the US Healthcare communities today. Everyone seems to have a strong opinion on the matter based on their background in the modern healthcare system. Not only does this distract from the real issues involving the glaring flaws of the US Healthcare system, but it is also super effective at blocking the conversation from ever moving forward. This is not at all surprising given how effective polarizing media campaigns are at shaping people’s perspectives. And honestly, I have fallen into this trap as well (many times).
This all got me thinking, “Why do we all have so many opinions about PA autonomous practice rights anyway?” In this article, I will explore why I believe this is even an issue, try to de-escalate the conversation, and provide an off-ramp from the polarization express train that has many of us captive.
What is a Physician Assistant?
I am a proud PA, but I will be the first to admit that our branding has A LOT of room for improvement. So, before I answer, “Why PA autonomous practice rights are so important,” allow me to answer, “What even is a PA?”
A PA (the new name is Physician Associate) is a highly trained medical professional who works under the ‘supervision’ of a licensed physician. We are mothers, fathers, friends, neighbors, and everything else in between. The PA profession was created in the mid-1960s to improve and expand healthcare access. Ever since the PA profession has consistently topped the charts of the U.S. News Rankings for Best Jobs. PAs are trained to provide a wide range of medical services, including conducting physical exams, diagnosing, and treating illnesses, ordering, and interpreting diagnostic tests, prescribing medications, and counseling patients on preventive healthcare measures.
PAs are trained under the medical model and work in a variety of healthcare settings, including hospitals, clinics, and physician offices. They are highly valued members of the healthcare team and work closely with physicians, nurses, and other healthcare professionals to provide high-quality medical care to patients.
PAs undergo extensive training, including completing a rigorous master’s degree program and passing a national certification exam. They are licensed and regulated by state medical boards and must participate in ongoing education and training to maintain their certification and stay up to date with the latest advances in medical practice.
According to the US Bureau of Labor Statistics, in 2021, there were currently over 132,000 PAs employed and around 30,000 PAs in NY and California alone. Projections state that the number of PAs will increase by 31% in the next 10 years — an astounding growth rate that adds up to more than 40,000 new jobs for PAs. By 2030, nearly 170,000 PAs will be practicing medicine in the U.S.
Why are PA Autonomous Rights Needed?
The state of US healthcare is a complex and deeply concerning issue, and it’s difficult to overstate the gravity of the situation. The US spends more on healthcare per capita than any other country in the world, yet it consistently falls short in terms of providing access to affordable and effective healthcare.
There are also significant disparities in healthcare outcomes based on factors such as race, ethnicity, income, and geographic location. Certain populations, such as people of color and those living in rural areas, are more likely to experience poor health outcomes and limited access to care.
Lastly, the US is currently facing a primary care provider shortage. According to a report by the Association of American Medical Colleges, the US is projected to face a shortage of up to 139,000 physicians, including up to 55,200 primary care physicians, by 2033.
This shortage has significant implications for the healthcare system and patients. The shortage is driven by a variety of factors, including an aging population, increasing rates of chronic disease, and an inadequate pipeline of medical students pursuing primary care specialties. Additionally, the COVID-19 pandemic has further exacerbated the shortage, as many healthcare workers have been stretched thin or have left the profession entirely.
With rising healthcare costs, significant disparities, and a primary care provider shortage, the growing PA profession is perfectly suited to address these massive shortcomings in the US Healthcare system. It could easily grant an experienced PA autonomous practice rights who have worked at least 8000 clinical hours the opportunity to provide services to patients where providers are limited, and disparities are present. This would seem like the obvious answer, right? Well, I guess it is not too obvious because, across the US, PA autonomous practice rights continue to be restricted.
But why?
Can Physician Assistants Practice Autonomously?
This is a common question for many experienced PA and the answer is, “It depends”. Every state is a little different, so it is important to check your state’s PA scope of practice laws, and I highly recommend speaking with a good healthcare lawyer licensed in your state.
Though most of America prohibits it. At the time this article was written, 47 US states exclude PA autonomous practice rights, and 24 US states exclude Nurse Practitioners (NP). There is a key barrier that is also important to understand fully — the corporate practice of medicine doctrine.
What is the Corporate Practice of Medicine?
Corporate practice of medicine doctrine? “What’s that and why does it matter, you ask?” First, let me start by saying it is the well-intended but largely outdated doctrine that I believe is holding back healthcare innovation and progress.
In a nutshell, corporate practice of medicine refers to the restrictions on non-physician entities from owning or controlling medical practices. This means that companies or corporations that are not led by physicians are not allowed to practice medicine or employ physicians directly. That’s a key point. If you are not a physician, then you cannot own a medical practice.
The doctrine’s original aim was protecting patients from deceptive behavior that might come with private ownership such as the commercialization of the practice of medicine, the imbalance between patient obligations and stakeholder obligations, and the interference of a physician’s medical judgment due to outside influences. As mentioned above, very well-intended.
But here’s the issue: this doctrine was written in the early 20th century well before PAs and NPs even existed. The healthcare landscape has evolved tremendously since the corporate practice of medicine was created, yet this doctrine continues to be the authority of medical practice ownership in the US.
The issue here is not the doctrine itself but who it chooses to include and who it chooses to exclude and why.
Understanding the Fight Against Physician Assistant Autonomous Practice
“Follow the money” is a catchphrase popularized by the 1976 docudrama film All the President’s Men, which suggests political corruption can be brought to light by examining money transfers between parties.
Even my mother taught me to “follow the money” when I was confused about how any employer largely functions and operates. The catchphrase implies that the flow of money will tell you the true story. So what is the true story behind the ongoing fight to prevent PAs and NPs from participating fully under the corporate practice of medicine doctrine? Well, let’s “follow the money” to find out.
As the PA and the NP professions continue to grow, there is a palpable tension within the physician community and the American Medical Association (AMA) against PAs and NPs ownership. Their main messaging point — is patient safety. They refer to the PA and NP’s advocacy to address the US Healthcare shortcomings as “scope creep” and use the hashtag #stopscopecreep to raise awareness on how PAs and NPs would put patients at increased risk if experienced providers practiced autonomously. On the AMA’s website, they explicitly smear PAs and NP’s patient care and even tout how successful they are at preventing PAs and NPs to participate fully in solving America’s healthcare crisis.
Since 2019, the AMA secured over 100 state legislative victories stopping inappropriate scope expansions of nonphysicians.
So let’s talk about it. Do experience PAs and NPs who work autonomously put their patients at an increased risk? I mean surely the AMA would only make this very bold claim with clear evidence from peer-reviewed studies proving the extensive neglect and malpractices among PAs and NPs who are practicing autonomously. Modern western medicine is practically founded on the idea of utilizing double-blinded clinical control trials to guide medical management and remove bias.
Well … there is no such study. Furthermore, there is no known proof to suggest that experienced PAs and NPs who work autonomously place patients at increased risk. So, if there is no proof, then why would the AMA say this? (Remember, “follow the money”)
A 2023 Health Affairs study, reveals how private equity firms that acquire physician-owned medical practices are designing their workforces to meet the demand of scale. But before I spoil the surprise, let’s see if we can figure this out together through a thought experiment. Now, you are a private equity investor, and you are good at what you do. You acquire a physician-owned practice and like any good investor, you need to maximize profits by increasing revenues or cutting costs. So, who would you utilize in your healthcare workforce to deliver safe and effective medicine to your patients at scale all at a reduced cost?
Ding ding ding — you got it! No other than PAs and NPs aka Advance Practice Providers. The study notes:
Relative to non-private equity acquired control practices, we found significant yearly increases in the number of advanced practice providers at private equity acquired practices after acquisition. Taken together, these findings suggest differential changes in workforce composition at private equity acquired practices, especially a shift toward advanced practice providers for care delivery.
No matter how you feel about private equity investors entering the medical field (and I have a lot of feelings because I work for one), one thing is certain, PAs and NPs will be a part of it.
These out-of-touch national campaigns against experienced PA autonomous practice rights need to be called out as baseless and as fearmongering. — Mike Rubio PA-C
PAs vs Doctors
To be clear, it is never PAs vs Doctors or NPs vs Doctors. This is the sensationalized fight that does not serve our patients. We are all on the same team. We all need each other to make US healthcare function better.
Anecdotally, many of my PA colleagues are married to physicians. To save you from another thought experiment, if the physician-spouse argued the AMA’s smear campaigns to their PA-spouse during dinner, then there would be a high likelihood that they would be sleeping on the couch that night.
In all seriousness, experienced PAs and NPs are not only trusted by physicians across America but also by countless patients. Sadly, there are no national numbers to back this claim as it is not a required reporting (side note: it absolutely should be required reporting) but thankfully we do have prescribing numbers.
With over half a million licensed Advanced Practice Providers in the United States, NPs and PAs wrote 1.17 billion unique prescriptions, which equates to about 2,281 prescriptions per prescriber between October 2021 and September 2022, according to POCN’s Total Office Data and True Rx proprietary Rx attribution algorithms. That means NPs and PAs were responsible for nearly one-third of all prescriptions written.
Let that sink in for a minute.
5 Ways to Advocate for Physician Assistant Autonomous Practice Rights
It’s time for all policymakers and stakeholders in the healthcare industry to allow experienced PA autonomous practice rights who have completed 3600 hours of direct clinical care so that they can contribute more fully to the US Healthcare system and their patients.
The AMA’s million-dollar fight against blocking PA autonomous practice rights to expand healthcare services shows how badly they want the status quo of the failing US Healthcare system. PAs and NPs have always made it clear that we want to work with physicians, in the same way, physicians collaborate with other physicians every day.
Fear not, the US Healthcare system is so bad that there will be plenty of room for all of us to be incredibly busy. Although friendly competition is needed, the war should not be with each other; but against how unsustainable this current model of healthcare is to the American people.
To help build national and state awareness and to ensure each PA’s work is being acknowledged, PAs can do the following:
1. Obtain Medicare, and Medicaid ID numbers and enroll as a provider in all the private payers your office accepts. (Ask your billing team if you are unsure how)
2. Submit claims under your name whenever appropriate.
3. Confirm that all e-prescriptions are under your name every time.
4. Advocate for your name and your title to be on your company’s website along with your bio and schedule listed.
5. Ask your employer for access to your yearly billing claims summary to add more transparency to your work within your company or organization.
Final Thoughts
In actual daily clinical practice, experienced PAs are utilized fully autonomously to deliver safe and effective care across the US every day. Many physicians, private equity investors, and pharmacies understand our true potential very, very, very, well.
As the country regroups from the devastating loss of COVID-19 to our countrymen and countrywomen, we must face that the US Healthcare needs are growing far faster than we can keep up. Restricting a qualified, good standing, and experienced PA autonomous practice rights but at the same time trusting them to run medical clinics fully autonomously is hypocrisy at its finest. It is either we are not capable, or we are capable, but you cannot have it both ways.