On the Brink of Change: NP, PA Leaders' Hopes for 2009

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For the first time in eight years, a new year brings a new administration to the United States. Most Americans, regardless of their political persuasion, seem ready to embrace what they hope will be a complete change from the status quo.

Patients and health care providers alike will be watching to see whether President-Elect Barack Obama, his Cabinet, and the 111th Congress can initiate the wholesale health care reform the nation needs. Clinician Reviews asked American Academy of Nurse Practitioners President Diana “Dee” Swanson, MSN, NP-C, FAANP, and American Academy of Physician Assistants President Cynthia B. Lord, MHS, PA-C, for their perspectives on what’s ahead—and how NPs and PAs fit in.

What are some of the challenges of working with a new administration and new members of Congress, and how do you work around those obstacles?
Swanson: I would say, probably, having the kind of recognition that we need. There are a lot of loud, moneyed voices out there that dominate the conversation—primarily physician groups and insurance groups. Hopefully with the new administration, they will listen to new, fresh voices—because clearly, the voices that have been heard to date have not offered any solutions to the problems that we face. All they’ve offered is more of the same, with their hand out, asking for more money.

My personal high priority is that we get a seat at the table with the Obama transition team. We have got to get in on the ground floor with a new administration, and it is imperative that we be able to meet with [Secretary of Health and Human Services nominee] Tom Daschle and discuss what we can bring to primary care.

Our health care system is floundering; we all know that. Primary care is floundering. Only 2% of medical school graduates are choosing primary care. There are 125,000-plus NPs out there prepared to provide primary care. We’ve got barriers all over the place to being able to efficiently do that. So my personal priority is to be at the table with the transition team.

Lord: Two things that we’re going to focus on are time and education. We’ve worked with Senator Daschle’s office before, so there are legislative aides and people that we know. But certainly with the new administration and members of Congress to contact, that’s going to take some time. So we’re already well into making those initial contacts, and certainly we’ll call in PAs from various states to help out in key areas.

The other thing that’s going to be required is education, because it is our job to explain why the issues that affect PAs actually affect the ability to provide quality, cost-effective care to patients, and how that impacts patient care. Although we have a number of friends who are still in Congress and in those positions of authority—so we won’t have to start from square one—there’s going to be that whole new regime that comes in.

So I think time and education are going to be our biggest challenges but also opportunities—because we’re not the same profession we were even 10 years ago. We’re not what we were 40 years ago. And we can certainly cite more areas where PAs have made an impact.

Based on what you know about the Obama-Biden health care proposal, how effective do you think the plan is in terms of addressing the nation’s health care problems?
Swanson: From my perspective, it’s a good start. Nobody in the last eight years has seriously addressed health issues at all. I don’t know how it will play out. Clearly, there are a lot of pressing issues—the economy notwithstanding—that will affect the ability of the new administration to implement changes.

I suspect that what we will see will be a collage, I suppose, of existing systems and structures. I think the idea to use the federal employee health model is admirable. Whether President-Elect Obama’s actually going to be able to get that implemented.… Certainly, he has a majority in the House and Senate, [but] not enough to prevent a filibuster, which I’m sure is going to be a challenge when you’re threatening large groups like health insurance companies.

I think his heart is in the right place; I just think there are a lot of factors that won’t come into play until he actually is in office and starts dealing with people. And I think it’s easy to envision what you’d like to see, and it’s another thing to get down to the nuts and bolts of how to make it happen. But I hope they listen to new voices. I hope that they are as open as they seem to be.


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