LAS VEGAS -- From burdensome licensing procedures to narrow scope-of-practice laws, legal and policy staff at the American Academy of PAs described state laws and regulations that prevent physician assistants from delivering the best care for patients at the group's annual meeting here.
AAPA's advocacy team also offered specific advice for rewriting legislation they argue is out-of-date and out-of-touch.
They urged all PAs to play a role in lobbying their state legislatures for needed changes.
"Don't think you have to start big, but you have to do something," said Ann Davis, MS, PA-C, vice president of constituent organization outreach and advocacy for the AAPA.
Barriers to Care
A handful of states continue to require "archaic" licensing procedures, said another AAPA official, Stephanie Radix, JD.
For example, some states mandate that PAs must obtain letters of recommendation or complete an interview before the medical board to gain their license, she continued.
In some states, these reference letters must be written by a licensed physician who is not the PA's future employer or a training director.
"As a newly graduated PA, this can be a difficult condition to meet since the only physician or PAs they may know are the ones at their training programs," Radix wrote in a follow-up email to 乌鸦传媒.
Other barriers to practice include mileage restrictions -- requiring PAs and supervising physicians to work within a certain proximity to one another -- and limitations on specialty practice.
As an example, in some rural areas, a patient's closest psychiatry practice could be hundreds of miles away. Allowing telepsychiatry visits with PAs could improve patient access and prevent patients from putting off appointments and potentially delaying treatment, Davis explained.
To achieve such changes, state laws must include PAs in the state definition of mental health providers, she said. Similar changes in relevant laws could enable PAs to practice teledermatology.
Seeking Solutions
The AAPA has been working with state constituents across other key areas:
- Enacting : a constantly evolving document which outlines best practices in PA regulation
- Improving licensing procedures: ensuring the licensing process is a purely administrative function with fewer bureaucratic hurdles
- Implementing harmonization acts: ensuring PAs are incorporated by name into legislation
- Ensuring PAs are included in workforce incentive bills
Model state legislation aims to ensure that states' scope of practice laws reflect a PA's education and experience and that a physician can no longer be in charge of delegating these parameters, explained Radix.
Nor should a PA's license be tied to a supervising physician's license -- a "completely crazy" problem that continues in five states, said Davis. The AAPA is working with its state partners to eliminate such requirements.
As for harmonizing legislation, AAPA is working with state chapters to ensure that PAs are included in all relevant bills to their practice. For example, PAs who aren't included on a list of mental health providers may not be able to order or provide certain services to mental health and substance use disorder patients.
"We want to have PAs specifically named on every list of healthcare provider that's in every state law or regulation," Davis added.
Regarding workforce incentive legislation, Davis cited a Georgia law that gave physicians who serve as preceptors for medical students, nurse practitioners and PAs a tax benefit.
Davis argued that PAs and advanced practice nurses who are also preceptors should be included in that law.
AAPA worked with other PA advocacy groups to lobby the legislature in Georgia, which ultimately amended the bill.
Reaching Goals
The AAPA experts celebrated several of its successes and those of state constituents:
- PAs have full prescriptive authority in 43 states and the District of Columbia
- PA scope of practice is based on education and training and determined by the practice and not the medical board in 37 states
- No chart co-signature is required in 29 states and D.C.
And Michigan enacted several significant changes to PA practice laws. One of these was a subtle but important change in language, from "supervising physician" to a "participating" physician," that Davis argued "elevates the practice" for PAs.
"If you have to think that you're going to be supervised by somebody in order to do anything, that's a balance of power that just doesn't serve us well," Davis said.
Plus, she said, physicians today don't necessarily want that obligation; many would rather do their own jobs and see patients.
"The idea that they have to take responsibility for somebody they may not see all that often... that's hard on them," Davis said.
In addition, Michigan is one of 13 states to repeal a ratio restriction that limits the number of PAs a physician can work with, she said.
Taking a Stand
Davis closed the talk with a final push for PAs to become stronger advocates for their profession.
Many PAs will tell her it's too difficult to talk to politicians, she said.
"In the last 30 days, have you told somebody that they have an STD, that they had to have an operation, that they need to change the location of an aging relative or that they have a diagnosis that's going to be hard to hear?" she asked the audience.
Nearly everyone raised a hand.
"You already do the most difficult communication in the world, so you've got the skills ... you just have to morph them over to another realm."