New AMA Policy Opposes Autonomous State PA Boards

At the annual meeting of the AMA, held June 9-14, 2017, delegates passed a resolution opposing autonomous state PA boards.

from AAPA

At the annual meeting of the American Medical Association (AMA) held June 9-14, delegates passed a resolution opposing autonomous state PA boards. This resolution was introduced following AAPA’s House of Delegates approval of Optimal Team Practice (OTP) last month.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Uncovering the “Hidden Value” of PAs

If a PA treats a patient but the service is billed under a physician’s NPI number, did the PA contribute any revenue to the practice?

from AAPA

If a PA performs a procedure but no one knows about it, did it really happen? If a PA treats a patient but the service is billed under a physician’s NPI number, or performs pre-op services that are covered under a global surgery payment, did the PA contribute any revenue to the practice? These kinds of questions are becoming increasingly relevant as health-care systems and public and private payers look to become more data-driven in their approach to determining the productivity and value of health professionals, and as healthcare transitions to fee-for-value reimbursement and rewarding quality.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

This Month, Everything Changed for PAs

After days of debate and years of dreaming, collaboration and study, an entire profession has embraced their future.

by Beth Smolko, MMS, PA-C

After days of debate and years of dreaming, collaboration and study, the resolution called “Optimal Team Practice” (OTP) came up for a vote in the American Academy of PAs (AAPA) House of Delegates (HOD). I remember hearing the Speaker call for all votes in favor and although there was a good response, I couldn’t tell if it was a majority. Then, the Speaker called for “all opposed” and there was silence. Pure, beautiful, silence. It was in that moment that an entire profession embraced their future.

In years past, a determined and legendary PA leader, David Mittman, started saying we needed Full Practice Authority/Responsibility in order for the PA profession to survive and thrive. Many PAs did not want to risk future PA legislation by angering physicians with FPA. We saw the fierce battles the NPs had to engage in and realized that we would have to fight the state Board of Medicine in almost every state without the same level of protection that comes from having your own state board (like nursing). As the years went on, we saw our nurse colleagues fight battle after battle, state after state, and even though the physician groups bemoaned their success, they didn’t cease to hire NPs. In the past year, it became clear that physician groups were actually preferentially hiring NPs due to the reduced administrative burden, over “dependent” practitioners like PAs. PAs who felt that physicians would continue to hire them due to PAs practicing in the same “medical model” or staying “in our place” were sadly mistaken. As physicians had increasingly become employees instead of solo practitioners, they no longer wanted the professional liability that comes from having to “supervise” another professional.

Almost two years ago, I led an advocacy team for primary care PAs (AFPPA) joining with the PAs for Tomorrow (PAFT) and Brian Sady (a passionate educator from Nevada who wrote a comprehensive white paper on FPA for PAs) to address PA practice authority. We worked diligently to create a resolution to bring to the 2016 AAPA HOD to introduce Full Practice Responsibility (FPR). There was vigorous debate on the house floor but ultimately the resolution was referred for further study. From this point, the HOD and AAPA Board of Directors (BOD) formed the Joint Task Force on the Future of PA Practice Authority (JTF). The JTF reflected the diversity found in our profession. It was made up of clinically practicing PAs, educators, state PA leaders, and two PAs who work for the Veterans Administration. It was a group that would have to come to consensus on ideas and language that would be best for our patients, our profession, and our stakeholders.

Over the past 10 months, the JTF worked with AAPA staff to create the most transparent and member-engagement driven process in our organization’s history. They sought to understand the wishes, needs, and will of their constituents. The concept was named Full Practice Authority and Responsibility (FPAR) and consisted of four “pillars”:

  1. Emphasize the PA profession’s continued commitment to team-based practice.
  2. Support the elimination of provisions in laws and regulations that require a PA to have and/or report a supervisory, collaborating, or other specific relationship with a physician in order to practice.
  3. Advocate for the establishment of autonomous state boards, with a voting membership comprised of a majority of PAs, to license, regulate, and discipline PAs.
  4. Ensure that PAs are eligible to be reimbursed directly by public and private insurance.

A survey was released on FPAR with over 12,000 PAs responding and over 71% in favor of the concept. The AAPA held calls with state chapters, specialty organizations, students, program directors, PA Administrators, past presidents and a variety of other PA leaders, as well as external stakeholders to field questions and explain the concept of FPAR. The AAPA also received thousands of emails, comments on social media, and letters regarding FPAR. PA leaders met with multiple physician organizations to discuss the proposal under consideration. By March, it appeared clear that this would be the way forward, but slow deliberation is the hallmark of PA leadership. During the Leadership and Advocacy Summit held in March 2017, we heard concerns from some attendees, including PA educators, which led to rethinking the name and some of the language originally proposed by the task force. As the pillars would directly impact AAPA’s Model State Legislation, they were added to the guidelines document as opposed to creating a “stand alone” resolution. The pillars were given a new name — “Optimal Team Practice” (OTP). This change in language gave some assurance to PAs that felt teamwork was important to emphasize. They wanted it to be clear that PAs weren’t going “rogue”, but rather wanted to be better teammates by not burdening any other teammate with “supervision”.

So, once again, I found myself on the floor of the HOD last week, asking for my colleagues to consider the future of our profession and the impact OTP would have on patient access to care. And after two days of debate, it ended in silence… followed by cheers, tears, and emotion unlike anything I’ve ever seen from our profession. It was a moment that changed everything – how PAs see themselves as a profession, where we belong in the healthcare landscape, and how we can expand access to care for our patients.


Beth Smolko is a certified PA with experience in primary care and occupational health and wellness. While in PA school, Beth volunteered in a mobile medical unit in Tucson, AZ which ignited her passion for bringing quality medical care to the underserved outside the walls of a clinic. Beth is a recognized leader in primary care with professional roles that include: Director-at-Large, American Academy of PAs (AAPA); Past President of the Association of Family Practice Physician Assistants (AFPPA); PA Representative at the 2013 and 2014 World Hepatitis Day meetings held at the White House; HCV Testing Recommendations Implementation Panel – Healthcare Providers (Centers for Disease Control). Participant representing PAs in the discussion on the Implementation of Hepatitis C Screening Recommendations for Patients born between 1945-65; Preceptor for George Washington University, Franklin Pierce and Salus University PA Programs. Preceptor for LECOM. Preceptor for University of Michigan Nurse Practitioner program; Guest lecturer for Mary Baldwin – Murphy Deming and George Washington University PA program speaking on “Pulmonary Disease” and “Family Medicine”; President and Founder of The Heart of Medicine, a non-profit connecting healthcare providers with patients desperately in need of care in Haiti.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

PAs Vote to Advance Profession to Meet Modern Healthcare Needs

PAs pass policy to enhance their ability to meet patient needs and ensure future of the profession.

from AAPA

At the annual conference of the American Academy of PAs (AAPA), members of its House of Delegates unanimously approved Optimal Team Practice, a new policy intended to enhance the ability of PAs to meet the needs of patients and ensure the future of the profession in a changing healthcare marketplace. This historic action comes during the 50th anniversary of the PA Profession, which was initially created to improve and expand healthcare.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Research on the PA Profession: The Medical Model Shifts

In an era where demand for medical services is outstripping supply, a good idea born in the 1960s is emerging as a medical innovation domestically and globally.

from JAAPA

Physician assistant (PA)-focused research arose in response to the idea that an assistant to the busy physician could improve healthcare delivery. The process of answering questions about the profession has involved multiple approaches and various scholarly disciplines. In the course of this undertaking, what emerged were three stages of examination of PA behavior. The bibliographic span from this period contains about 2,400 studies that advance some notion of PA benefit to society. On the 50th anniversary of the PA profession, a question arises as to what research has shown. The answer is that PAs are providing care at significant levels of quality and quantity and their presence is enriching many challenges in healthcare delivery. In an era where demand for medical services is outstripping supply, the good idea born in the 1960s is emerging as a medical innovation domestically and globally.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Do NP, PA Ordering Habits Lead to Higher Healthcare Costs?

A study found that primary care provider ordering habits may result in higher healthcare costs versus the habits of nurse practitioners and physician assistants.

from RevCycleIntelligence

Nurse practitioners and physician assistants did not contribute to higher healthcare costs by ordering more ancillary or expensive services compared to primary care providers, a recent American Journal of Managed Care study uncovered.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Outside the Clinic

There are many options for PAs beyond clinical work.

from AAPA

Do you ever wonder about the options for nonclinical employment open to you as a PA? There are many available. AAPA has highlighted 10+ possibilities, as well as some questions to ask yourself to see if non-clinical work is a good fit for you.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Equipping PAs for Expanded Opportunities in Healthcare

Nearly three-quarters of PAs now say that their main area of practice is in a specialty other than primary care.

from AAPA

Many factors, including consumer empowerment and a heightened focus on healthcare quality and patient safety, are increasing the scrutiny of how providers develop and demonstrate clinical competency. The PA profession has been changing as well, with the percentage of PAs practicing in non–primary care specialties rising steadily over the past two decades.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Dave’s Blog: Let’s Level the Playing Field

You can’t lead if the cards are stacked against you from the start. You can’t lead if the playing field is not level and ours has never been.

by Dave Mittman, PA, DFAAPA

I am not sure why some in the profession do not see why we must grow, must evolve. Why we have to change with the times, not for change sake, but because we have earned the change. Why if we do not, we will leave ourselves behind on so many levels.

What I’m talking about is the need for Full Practice for PAs. No, not practicing ALONE as some would have you believe, just practicing as we do today. No, not rejecting teams, or angering people who in reality have no business being angry, but just being who we already are. Just with a small shift, same as NPs have done in 22 states, PAs being responsible for what we do each day. Signing our names and by doing that saying “I did that”. Full Practice Authority and Responsibility. Something about that notion scares some of us. I am not sure why? Maybe you can tell me? To me it is the natural progression of all groups of people to want to grow and take responsibility for what they do. It’s what professions have always done. It’s what people do. Legally, the majority of NPs need to do this also. It is only in 22 states where they have Full Practice also. PAs now have some sort of collaboration in two and a hybrid of some aspects of FPA in one.

I was reading about the great Jackie Roosevelt Robinson. The man who played baseball for the Brooklyn Dodgers one block from where I grew up. He had limitations placed upon himself because of the color of his skin, not his skill. He was told by many people in his day to not to be the first to enter the major leagues. His life was threatened. He was told it was “too soon”. That there was “no need yet”. The Negro Leagues were fine and had great players with teams that did well economically. That it was too early to “rock the boat”. Jackie continually said he only wanted a chance to show America what he could do. He was not about rocking boats, nor was he trying to anger anyone. He wanted the same thing everyone else in his field had, the ability to determine his own future. His feelings resonated with me. I want the same only in PA terms. I want no parades, no medals, nor do I want to say I am an island, any more than Mr. Robinson could have been able to play baseball alone. He knew he needed teammates. He recognized he was part of a team but until the day he walked on the field, as a free and equal representative of his people, he also knew he was not fully a free man. Until the time when PAs own their own profession, take responsibility for it, and determine our own futures, we simply cannot be a fully free profession. To be beholden upon anyone else for the right to work after five, ten, twenty or fifty years of proving you are totally competent at what you do, robs you of your self-esteem. I don’t think we see what that does to us, but it’s effects are there. To have someone else responsible for your actions as a 35 or 45-year-old person is not healthy. To say that we are responsible for what we do, is all I want.

Full Responsibility or Optimal Team Practice will allow us to grow as a profession and as individuals. Our options will increase. We will walk and talk differently. We will look at everything we do in a different more positive light. And most importantly, we will join the ranks of every other medical, nursing and health profession who determine their own destinies every time their own Boards meet.

You can’t lead if the cards are stacked against you from the start. You can’t lead if the playing field is not level and ours has never been. You can’t lead if you are not willing to be responsible for yourself. You can’t lead if others already have significant advantages over you by legislation and by a system that legislates others to lead you. You can’t lead when the law says others have to “supervise” you every day of your professional life. Allow us to lead and I know we will show the world just how innovative, just how smart and just how committed we are.

All I want is a level playing field. If that angers some people, so be it. I am not worried about someone else’s anger. I believe they will see our point but even if they do not, the sky won’t fall. Everyone will eventually go back to doing what they do best. Our NP colleagues in 22 states have shown us that. But this goes farther than competing with any other profession. This is about who we PAs are and who we want to be. We could “leave well enough alone”. But that’s not how people progress.

Just ask Mr. Robinson.


Dave Mittman has been a PA and later NP leader for thirty years. He co-founded the LIU PA Program student society, was President of the New York State Society of PAs from 1978-1979 and served on the American Academy of Physician Assistants (AAPA) Board of Directors from 1981-1983. Dave was also the first USAF Reserves PA permitted to practice. Dave spent 9 years in primary care in Brooklyn, N.Y. and left to begin a career in medical publishing with Physician Assistant Journal. Dave has also won the AAPA Public Education award for leading the march in Trenton NJ to establish PA practice. Dave left PA Journal to co-found Clinicians Publishing Group (1990) and Clinician Reviews Journal in 1991. Dave has authored papers in publications as diverse as “Chicken Soup for the Expectant Mothers Soul”, “U.S. Pharmacist”, “The British Medical Journal” and others. Dave¹s paper in the BMJ was the first internationally written paper written on PA practice. Dave and a few very close PA colleagues co-founded the PAs For Tomorrow”” in 2012 which is a new national professional organization representing and advocating for PAs in an different way. Dave as spoken at hundreds of NP and PA meetings and always has some interesting thoughts on the future of both professions. Most recently Dave has been busy launching another dream; Clinician 1, the first internet community for PAs and NPs. Dave is married to his sweetheart Bonnie for 32 years and has two wonderful children.

Communication Is Key to the MD-PA Team

One MD discusses the core building blocks he has found to be essential to developing a productive MD-PA relationship.

from JAAPA

My first interaction with physician assistants (PAs) occurred when I was 8 years old and was rounding with my father in the hospital. My father was a PA. Through him, I saw what PAs could accomplish: the ability to flex to all areas of medicine, the capacity to maximize responsibilities through strong mentorship, and the ability to positively affect patient care.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.