Title of Proposal:

Amending current Physician Assistant Code to reflect current practices in Medicine

On behalf of:

Virginia Academy of Physician Assistants

Describe the Idea or Issue:

To better reflect current medical practices, harmonize Code with existing regulations, and improve access to care

Desired Outcome:

The introduction of legislation that will;

• Change the definition of Supervision to Collaboration,

• Remove physician liability, except in cases of physician directed care,

• Update Code to reflect current standards of practice,

• Remove current required language requiring attestation in the practice agreement by the physician to allow the establishment of a final diagnosis or treatment plan,

• and remove the barrier as to how many PAs a physician may supervise

Background/Supporting Information:

The delivery of health care by the Physician-PA team continues to undergo change. With the development of unique practice environments, practices need to have the flexibility to respond to rapidly expanding demands. The practice of PAs working side-by-side with physicians on a daily basis has grown to more remote relationships, simply to respond to the ever-increasing demand for access.

The Physician-PA relationship has undergone change, when often the patient load is shared and the care plan jointly determined. The PA profession has grown and proven itself; when initially critically watched and directed (supervision), the practice standard now is more of jointly determined care with willing assistance (collaboration). Indeed, the term supervision has been misunderstood in the administrative world, risking disenfranchisement. The term collaboration will ensure ongoing communication between the Physician and PA team, ensuring the delivery of safe, cost-effective, and quality health care that the patients we serve will benefit from.

The recommended updates to Code will maintain & strengthen the Physician-PA team, while removing unnecessary liability to other team members.

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I disagree with the last line regarding removing the barrier for how many PAs a physician can supervise.  Teachers know well the limits on class size and what happens when it is too large. Removing the barrier on reasonable expectations of collaboration is an invitation to abuse by physicians and amounts to our endorsement of independent practice.

We likely need some codification of the PA/MD role....Good luck maintaining suprvision or collaboration without liability. The trial lawyers will need to get "on board" first (right after they start selling sno-cones in hell).

Seems like PAs want to become doctors without going to medical school, this is absolutely absurd.

So again....what’s the point of medical school and residency again? What is the point of making premed students go hundreds of thousands of dollars into debt and delay ‘real world income potential’, delay ability to significantly contribute to 401k’s, delay ability to start a family while working 80 hrs a week and overnights etc for over a decade while they seek proper education and training to PRACTICE MEDICINE INDEPENDENTLY!!! We really need to look at this from medical student and resident perspectives. Why do we make an MD (aka finished medical school and passed step 1,2 of USMLE as Intern) jump through hoops to ‘practice’ dermatology, neurology, psychiatry, pediatrics, insert XYZ medical specialty here when a lay person off the street can  BYPASS ALL of this to practice MEDICINE Independent of MDs/DOs in this country and ‘dabble’ in various specialties if they happen to come across XYZ specialist who is willing to clinically train and mentor them for 5 years etc? What are we doing to this nation of future  physicians especially those who are office based and should get paid for their cognitive skill set not how many scopes or procedures they can do. CMS and ‘payors’ see MDs/DOs as equal to PAs and NPs. It’s quite obvious bc they can bill and code for the same services regardless of how superficial the quality of care is from an Np or PA who didn’t compete proper medical school and residency. The writings on the wall. How dare we agree to mentor and train NPs for ‘5 years’ and XYZ clinical training  hours and then pass them off to Independent Practice of MEDICINE. How dare we. Focus on what matters to OUR PROFESSION. Focus on medical students and residents. Stop allowing nurses to feed off our hard earned education and training that we paid in time, sweat, tears and financial debt to attain.

Good luck getting any physicians to "collaborate." A physician has 4 years of undergrad, 4 years of medical school and a residency that could last 3+ (5-7 years for some sugical specialities) years before they are allowed to practice independently. A PA has 4 years of undergrad and 25 months of PA school (which includes a 1 year clinical rotations). The difference in education is signficant.  If you remove the physician liability the PA must be ready to assume malpractice. 

what is rhe lirpose of medical school? To ensure that the practice of medicine is held to the highest possible standard. Don't be fooled by charlatans trying to practice medicine without gong  to medical school and residency. I know physicians who used to be NPs and PAs. They all say the same thing: they were brainwashed in their schools to believe that they were equivalent to physicians- but once they decided to go to medical school (and had to re-take the prerequisite science courses to even apply bc the science courses they had taken were low-level and too easy)- they realized  they had been lied to. There is no substitute for medical training. None. You are in charge of protecting the public. So protect the public. 

I strongly object to the above proposal.  The role of the physician assistant is to assist a physician with their practice, not replace a physician in practice.  Physician Assistant education includes one year of academic studies and one year of clinical rotations.  There is no residency for a physician assistant.  They are sent out into practice after this most basic of educations.  Physician assistants neither receive the depth or rigor of training that a physician's training does.  The plan of care should rest with the supervising physician as in all reality this is who will be responsible for any outcomes.  In addition, the number of PA's a physician should supervise should be limited in order to ensure the highest quality of care for patients.  Physician assistants should have an on site supervisor who can directly supervise their delivery of care.

Just like any midlevel provider, PAs play an important role on the healthcare team BUT should have proper physician supervision. 

Just like any midlevel provider, PAs play an important role on the healthcare team BUT should have proper physician supervision. 

I have worked with the nurse practitioners and PAs, They can be very helpful on a healthcare team but in no way should be practicing independently. The amount of mistakes that I catch are ridiculous. Patients can be seriously harmed. If they do not have the training, why would you let them practice independently? They literally tell me the wrong diagnosis, the wrong plan.  A mid-level provider who has been practicing for 20 years Recently gave my patient a water pill instead of letting her know she was in florid kidney failure. If the patient hadnt called me, this would not have been picked up. Losing your kidneys is not something anyone wants. They should NEVER practice independently 

Independent practice by PAs and NPs is risky for patients well being. Physicians don't have time to supervise everything midlevels do and at the end there are more health care costs when midlevels order unnecessary tests and medications. Their role is to be part of the team, not independent. 

I disagree that PAs are being disenfranchised and perhaps some physicians are not appropriately supervising their PAs, which should be the focus of any legislative agenda. How can MSV support initiatives to combat physician burnout and simultaneously devalue our degrees by granting independent practice to NPs and now walking in the same direction with PAs. No doubt there is a physician shortage, but also a residency shortage, and unnecessarily arduous path for foreign medical graduates and physicians to integrate into our system. It would seem more fruitfull to focus on enabling those medically trained individuals to practice medicine... rather than promoting NPs and PAs with significantly less rigorous and inconsistent training and unleashing them on the most vulnerable populations.