Commentary

Autonomy Now! Why PAs, Like NPs, Need Full Practice Authority

The author says experienced NPs and PAs are "held hostage" by collaborative agreements—and it's time for a change.

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Across the nation, states are dealing with shortages of health care providers.1 The situation is expected to worsen as the physician population ages and many retire from the workforce.2 Meanwhile, the number of medical schools—and graduates from them—continue to stagnate. Even when additional residency spots are created, relatively small percentages of MDs/DOs choose to practice in primary care. Combine these circumstances with the fact that the Affordable Care Act has injected a significant number of new patients into an already overburdened health care system and you realize that new innovations are desperately needed to increase access to care for patients.

Utilizing PAs and NPs to the full extent of their training will not only help alleviate the shortages but also increase the quality and accessibility of care. NP and PA programs are proliferating across the country and producing steadily increasing numbers of graduates.3 Many of these newly minted NPs and PAs choose to enter primary care settings to practice, where they help to lower health care costs, decrease malpractice rates, and yield excellent patient outcomes and satisfaction rates.4,5

Yet physician organizations and state legislators continue to resist efforts to give these experienced and well-trained providers expanded scopes of practice and full practice authority. In many cases, physician interest groups continue to lobby for restrictive laws that are not backed with any data.6

Patients continue to suffer from a lack of access to health care because of legislative battles between groups of providers over practice territory, money, and egos. Many patients have to wait extended periods to see a provider; in some rural areas, there may be no care available at all.

In these situations, experienced PAs and NPs are held hostage and unable to practice without collaborative agreements. Often, physicians demand monthly stipends (sometimes thousands of dollars) to act as a collaborator under such an agreement. In many cases, these “collaborating” physicians provide almost no oversight. Burdensome legislation stipulating supervisory or collaborative requirements—for which there is little to no supportive evidence—keeps health care costs higher than necessary, decreases access to care, and stifles any flexibility or innovation in health care.

NPs presently have full practice authority in 21 states and the District of Columbia and are recognized for their education and clinical training.7 They must, and will, continue to lobby and fight for full practice authority in the rest of the country. PAs must join in this effort by continuing to lobby for full practice authority for experienced PAs in primary care. It’s time PAs were also recognized by state legislators for their education, clinical training, and dedication to quality patient outcomes.

PAs are graduate-level educated providers with a wealth of knowledge and experience. PAs, like our NP counterparts, have 50 years of patient outcomes data and studies that prove we are effective and safe providers. Organizations such as the VA, the FTC, and other citizen advocacy groups support PAs.8-10 These organizations have supported NP independence and will support the push for PA practice autonomy as well.

The time has come to start the movement for full practice authority for PAs on a national and state level. Experienced PAs in primary care are ready for this challenge and should lobby for legislation that would allow them the option to practice without collaborative agreements. In states that have granted independence to NPs, the wording “practice alone or in collaboration with a physician” has been used, allowing flexibility in practice environments; PAs could use the same language in their lobbying efforts.

The criteria for PA autonomy will undoubtedly be debated extensively. For our NP colleagues, many states require a specific number of hours practicing with a collaborative agreement in place before independent practice is allowed. Since very little data exist that can direct the PA profession on the number of years a PA should practice before gaining autonomy, relevant NP legislative requirements could be used as a precedent.

For example, Nevada gives NPs the ability to practice without a collaborative agreement as new graduates. Connecticut gives NPs the ability to practice independently after three years of collaboration with a physician. There is little doubt that these are arbitrary numbers that were agreed upon at the state level—but PAs will face the same negotiations when lobbying for their right to practice autonomously.

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