OTP: Pipe Dream, Smoke Screen, or the Right Thing?



We live in a world of acronyms. OMG, GOAT, and the like are ubiquitous on social media and increasingly sprinkled into more traditional journalistic formats. But if you’re a PA, the most important acronym for at least the past two years has been OTP—optimal team practice.

In my February 2017 editorial, I opined on the related concept of full practice authority (FPA), discussing the hurdles the NP and PA professions face to achieve this goal (Clinician Reviews. 2017;27[2]:12-14). Both professions, now more than a half-century old, assert that they have demonstrated, through practice and research, a commitment to competent, quality health care. In recent years, these assertions have been increasingly centered around acquiring more autonomy and responsibility—what NPs refer to as the ability to practice to the fullest extent of their education and training. As a profession, the NPs have done an excellent job of breaking down unnecessary barriers to their practice.

PAs, however, continue to have challenges with this concept. To address this, a mere three months after my FPA editorial, the House of Delegates of the American Academy of PAs (AAPA) adopted OTP as a policy. The Academy says OTP is designed to increase access to care and help align the PA profession with modern societal health care needs.1 While the AAPA’s Guidelines for State Regulation of PAs continue to emphasize a commitment to team-based care, the OTP policy calls for changes in statutes and regulations that will

  • Allow PAs to practice without a formal agreement with a particular physician
  • Create separate majority-PA regulatory boards (or give authority to boards comprised of PAs and physicians who practice with PAs), and
  • Allow PAs to be directly reimbursed by all public and private insurers. (PAs continue to be the only health care professionals who bill Medicare but are not entitled to direct reimbursement.)

These changes encourage PAs to practice to the full extent of their training and remove restrictions that currently obstruct delivery of care.1,2 Yet there are unintended consequences as the profession pursues this path.

The Physician Assistant Education Association (PAEA), while supporting most of the OTP policy, has raised concerns about changing curricula to reflect increased autonomy, which would require longer educational programs and incur higher costs for students.3 A significant part of PA education for the past half-century has been the social integration into the health care realm with physicians. There is also concern that changes to accommodate OTP might ultimately lead to a requirement for PAs to have a doctorate degree in order to practice—although not everyone sees that as a drawback!

Proponents of OTP, on the other hand, insist that times have changed and the profession must change with them—or at least, the rules governing the profession must be amended to reflect practical realities. AAPA leaders believe that physician oversight provisions are no longer necessary, and that PAs must acclimate to the changing health care marketplace to solidify the future of the profession and meet the needs of patients.

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