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PA's for Tomorrow

PAs are a logical answer to America’s primary care crisis.

Posted on 23rd Feb 2022 04:03:38 in Physician Assistants

Tagged as: physician assistant, primary care, pa profession, pas for tomorrow, advocate, americas primary care crisis, paft, practice autonomy, education, tuition reimbursement,

PAs for Tomorrow (PAFT) believes that PAs are a logical answer to America’s primary care crisis. PAFT also believes that the opportunities for PAs as primary care providers are vast and immediately accessible. The PA community has the possibility to broadly define the future in this specialty. A progressive focus and defined framework will facilitate efforts to expand the presence of PAs as primary care providers.


PAFT believes the PA profession will succeed in ensuring a successful future in primary care if we advocate for:


Practice Autonomy

  PAs are members of a team. The practice of medicine is complex and requires creative utilization of all skill sets. PAs in primary care will require autonomous practice within that team framework to be fully successful. PAFT believes that present-day supervision requirements are a significant barrier to many PAs who would otherwise practice primary care in underserved regions. PAFT further believes that when fewer physicians practice in a given specialty and geographic location, PAs will also be fewer in number as a direct result of antiquated supervision requirements. Supervision language in PA practice legislation is not conducive to autonomous practice, deterring well-trained PAs from primary care. Removal of supervision barriers to PA practice is critical to long-term successful utilization of PAs in this setting. Legislation conceived and enacted when the profession was unproven remains despite evolution and maturity of the profession. Language and laws that accurately reflect present-day PA practice must also evolve. Legislative reform allowing PAs full practice autonomy is imperative for PAs to practice at the top of their license and education.


  PA training produces a capable, qualified health care provider that is well suited for primary care practice. Uniform, standardized PA training as generalists offers exposure in all medical specialties. PAFT believes PAs who desire to practice with full autonomy would best succeed by completing residency training. Alternatively, PAs who spend a minimum of two years in family practice/primary care specialty under the tutelage of seasoned primary care providers will then be better prepared for autonomous practice as compared to a new PA graduate. In the interest of expanding training opportunities, the AAPA should seek federal funding to develop at least one PA primary care residency program in each state in the US.


Delivery Design and Practice Ownership Equity

  Identifying alternative ways of bringing quality primary care providers to underserved populations could be accomplished in a number of ways. One consideration could be an expanded retail clinic concept that allows PA ownership. Federal loan opportunities would ease start-up expense and bolster success for both independent and group practices. Practice ownership barriers for PAs should be eliminated in all states. PA equity and partnership will only foster clinician retention. PAs who have interest in or own a practice are more likely to remain vested long term. Further, PAFT believes that PAs should seek leadership roles in emerging primary care delivery systems including telemedicine care, home call services, PCP oriented urgent care and others. PAs are well suited and well trained to function in any of these capacities.


Tuition Reimbursement

  PA education is expensive. It has been anecdotally noted that high student loan debt deters many providers of all types from pursuing careers in family practice. PAFT believes that aggressive lobbying for loan repayment for any PA choosing qualified primary care practice is a viable solution. PAFT envisions repayment beginning after one year of practice. Repayment then continues for a period of three more years. To be free of educational debt, a PA would be required to maintain primary care practice for a period of no less than four years.


Reimbursement Equity

  Payment policies reimbursing PAs less than physicians for equivalent care hinders PA practice in primary care. Medicare, Medicaid, and private insurers typically reimburse PAs 85% or less than physicians for the same services. As a result, billing practices to capture 100% reimbursement is often the norm, “hiding” a PA’s financial contribution to a given practice. Additionally, primary care services tend to be undervalued compared to specialty providers of same or similar services, further lowering reimbursement. PAFT believes reimbursement inequity and devaluation of care must be eliminated.


Organized Medicine

  PAFT believes in a committed, comprehensive campaign to educate physicians, administrators, and policymakers of the PA profession’s utility as an immediate workforce of healthcare providers. This is critical for the successful promotion and utilization of PAs in this capacity. PAs are qualified and accessible but are hindered by constraints in both policy and legislation at multiple levels. PAFT believes that the PA profession should aggressively and progressively seek change in policy and legislation. The individual PA’s future and security are directly linked to the collective profession’s growth and evolution. The changes PAs seek are not to divide or separate from the healthcare team. To the contrary, these changes facilitate inter-professional collaboration, strengthen the medical team, foster innovative practice, and enhance the accessibility of high-quality primary care. Further, these advancements will also give us equity with other professions, which is critical if PAs are to be viewed by organized medicine as a viable resource.


Commitment to Further Research

  PAs provide primary care well – at least as well as our primary care physician counterparts. PAFT maintains that PAs as primary care providers of longitudinal healthcare exceeds the effectiveness of delivery platforms that offer more disrupted access to care. The only true measure to confirm that hypothesis is research. PAFT contends all delivery platforms of primary care services by all health care providers should be studied and documented. PAs leading patient-centered medical homes should be measured to confirm that PA outcomes are equivalent to or better than other providers of the same services. Cost savings and quality of care should be accurately researched by provider type. The contribution of PAs to the US healthcare system has been neglected by organized medicine as well as the PA profession. It’s time that contribution be accurately documented to support the utilization of PAs in the delivery of cost-effective, high-quality primary care services.


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