After a three-year legislative battle, physicians and physicians assistants in Tennessee say they are "mutually committed to continuing to improve access to safe and effective patient-centered quality care within an integrated, coordinated, physician-led team."
Doug Springer, MD, FACP, FACG |
The Tennessee Medical Association (TMA) and the Tennessee Academy of Physician Assistants (TAPA) are vowing to work together after a years-long divisive legislative battle splintered the relationship between the two organizations.
The split could have permanently damaged an important partnership at a time when midlevel providers, such as PAs, are being leaned on as a possible solution to easing the shortage of primary care physicians.
In 2012, state legislators passed a law, put forth by the TMA, that required a physician to be onsite when a physician assistant) or other mid-level provider administered a spinal injection to patients. PAs had been doing spinal injections without an onsite physician, and felt that the bill limited patient access to pain management therapy.
MDs, represented by the TMA, believed it was a patient safety issue, and after a three-year battle in the legislature, won the argument, but nearly lost a longtime ally. "It was a rancorous fight in the legislature," says TMA President Doug Springer, MD, FACP, FACG.
Leadership at TAPA agrees, and says the issue put the two organizations at odds for too long. TAPA's Executive Director, Katherine Pesut Moffat, says that after the law was passed, the organization approached TMA to find out how to move forward.
"It made us stop and say, 'We need to rethink this conversation and dialogue,' " says Moffat.
Both organizations met frequently over the last year and last week produced a joint statement:
"We, the Tennessee Medical Association and the Tennessee Academy of Physician Assistants, are mutually committed to continuing to improve access to safe and effective, patient-centered quality care within an integrated, coordinated, physician-led team."
The working relationship between MDs and PAs isn't one that has room for much contention. And knowing that professional organizations have the ability to set the tone for communication at the provider level, both TMA and TAPA leadership say sending out the joint statement reset the relationship and expectations.
"This joint statement is a giant first step," says Springer. "It's a message that it's time to focus on the future, not a rehash of the past."
Future of PAs
The first PAs began practicing alongside MDs in the mid-1960s. Their number has been increasing year over year for more than a decade. According the National Commission on Certification of Physician Assistants (NCCPA), at the end of 2003, there are 43,000 certified PAs in the U.S. That has grown to 100,000 this year, and projections are for more than 125,000 by 2018.
The reason for the exponential growth is the same reason the profession began in the first place: There is a shortage of primary care physicians. The longtime working partnership is one reason that physicians are comfortable with PAs in their practice, says Springer.
"The PAs have been an incredibly important part of medical practices," he says.
There are more than 1,400 certified PAs in Tennessee. They work under the supervision of a physician, with the power to prescribe, see, and diagnose patients. PAs are trained alongside medical students, taking pre-med classes, and spending time in clinical rotations. In practice, PAs function as team members with physicians as team leaders.
This staffing model, in many ways, is what hospital and health systems are working toward now, and this focus on team-based care is another reason the growth prospects for PAs is strong.
Removing Barriers
Despite the strong tenor of cooperation between the TMA and TAPA, PAs still have to work to secure their place on the medical team, and this potential tension exists in other states besides Tennessee.
While PAs have similar powers in all 50 states, plus the District of Columbia, there are still some barriers to PAs working at the top of their license. The National Governor's Association, seeing the potential for PAs to help relieve access issues, recently issued a 15-page whitepaper with several recommendations for states to encourage the use of PAs in medical practices. Among them:
- Increase clinical training opportunities for PAs
- Review legal definition of provider to make sure it includes PAs
- Develop financial incentives for PAs to work in medically underserved areas
Moffat says TAPA is focused on knocking down similar roadblocks in Tennessee.
"We are making sure that there are no barriers to PAs practicing at the top of their license, and at the highest level of their training," she says.
Patient Satisfaction
According to the American Academy of Physician Assistants (AAPA), their survey shows patients are ready for PAs to treat them. In fact, some states, such as New York, have models of care that allow PAs to be the primary care provider in a patient-centered medical home.
According to the AAPA's survey, 92% of 1,500 adults surveyed reported that access was better at a practice with a PA. From Moffat's perspective, it reinforces what physicians who utilize PAs tell TAPA.
"From member physicians, we hear, 'I love my PAs, they are trained to approach medicine like us.' "
Jacqueline Fellows is a contributing writer at HealthLeaders Media.