Fewer than Half of Physicians Own Practices

of Physicians Were Practice Owners in 19831

of Physicians Were Practice Owners in 20162

Decrease in % of Physicians Who Own Practices from 1983 to 20161,2

Financial Incentives for Physicians to Supervise

PAs are Changing

PA Experiences Validate Marketplace Obstacles

38%

76.1%47.1%

Physicians Are Increasingly Reluctant to Enter Into

Supervisory Agreements With PAs

...having a PA in the practice bringsno personal financial benefit

to them as employees

Physicians who are employeesdon't want to accept liability

for the PA because...

Physiciansaccept liability

of PA

PAs bring inmore business

Financialbenefit goes to the employer

PAs Face New Obstacles in a Changing Market

19 + D.C.201422 + D.C.2017

419908 + D.C.1998

16 + D.C.2012

Laws in Many States Do Not Require NPs to Have a Supervisory Agreement

Number of States Where NPsHave Full Practice Authority by Year3

Community Health Center CEOsMake PA vs NP Hiring Decisions

Based on Practice Laws4

Broader PA and NP Authority 5,6,7

IncreasesAccessto Care

Doesn’t Diminish

Quality of Care

Can ReduceCost of

Healthcare

45% of PAs say they have personally experienced NPs being hired over PAs due tosupervision requirements8

© American Academy of PAs 2017

1. Kane, Carol K. “Updated Data on Physician Practice Arrangements: Inching Toward Hospital Ownership,” AMA Economic and Health Policy Research, July 2015. | 2. Kane, Carol K. “Updated Data on Physician Practice Arrangements: Physician Ownership Drops Below 50 Percent,” AMA Policy Research Perspectives, June 2017. | 3. Summers, Lisa. “Update: Transition to full practice authority for APRNs,” http://www.theamericannurse.org/2016/08/10/update-transition-to-full-practice-authority-for-aprns/ | 4. Pittman, Patricia, Leah Masselink, Bianca Frogner, and Leighton Ku.“Factors Determining Medical Staff Configurations in Community Health Centers: CEO Perspectives,” Journal of Healthcare Management 61:5 September/October 2016: 364-377. | 5. Martsolf, Grant R., David I. Auerbach, Aziza Arifkhanova. "The Impact of Full Practice Authority for Nurse Practitioners and Other Advanced Practice Registered Nurses in Ohio" RAND Corporation, Santa Monica, CA, 2015. | 6. Timmons, Edward J. “The Effects of Expanded Nurse Practitioner and Physician Assistant Scope of Practice on Medicaid Patient Access,” Mercatus Working Paper, Mercatus Center at George Mason University, January 2016. | 7. Kurtzman, Ellen T., Burt S. Barnow, Jean E. Johnson, Samuel Simmons, Donna Lind Infeld, and Fitzhugh Mullan. "Does the Regulatory Environment Affect Nurse Practitioners' Patterns of Practice or Quality of Car in Health Centers?" HRS: Health Services Research 52:1, Part II, February 2017. | 8. AAPA, “2017 Full Practice Authority and Responsibility Survey Report: A Report to the Joint Task Force on the Future of PA Practice Authority,” February 2017.

*See citations below for data sources

In May 2017, AAPA’s House of Delegates approved a new policyto expand access to care and adapt the PA profession to the current healthcare marketplace

New Policy is Good for Everyone

Next Steps?

© American Academy of PAs 2017

PAs Poised to Advance Profession

will have greater access to healthcare

Patients Physicianswill be relieved of unnecessary administrative and legal burdens

PAswill be able to practice to the full extent of their education, training and experience

The New Policy Calls for Laws and Regulations that:

Emphasize PAs’ commitment to team practice with the degree of collaboration determined at the practice level

Create autonomous majority-PA boards to regulate PAs, or give that authority to healing arts or medical boards that have as members both PAs and physicians who practice with PAs

Eliminate legal requirementsfor PAs to have a specific relationship with a physician in order to practice

Authorize PAs to be directly reimbursed by all public and private insurers

The updates to AAPA policy represent a natural evolution of thePA profession. Patients, especially in rural and underserved areas, will benefit from

greater access to the high quality care that PAs provide.~ Bill Finerfrock, Executive Director, National Association of Rural Health Clinics

State PA chapters will decide whether and when to pursue changes to statelaws and regulations

AAPA will lay the ground work and advocate for statutory changes to Medicare to authorize direct PA reimbursement and eliminate physician supervision language in the definition of PA services

1

Frequently Asked Questions: Optimal Team Practice New Policy Adopted by AAPA in May 2017

What is Optimal Team Practice? OTP emphasizes the profession’s commitment to team-based care; reaffirms that the degree of collaboration between PAs and physicians should be determined at the practice level; supports 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; advocates the establishment of autonomous state boards with voting membership comprised of a majority of PAs, to license, regulate and discipline PAs; and ensures PAs are eligible to be reimbursed directly by public and private insurance so they don’t remain hidden providers. Why have PAs made this change now? PAs are facing new obstacles in the changing healthcare marketplace and must adapt in order to meet the needs of patients and ensure the future of the PA profession. Twenty-two states and the District of Columbia allow Nurse Practitioners (NPs) to practice without a supervising or collaborating physician, which makes them easier to hire and manage. In addition, physicians are more likely to be employees, rather than practice owners, and no longer see a financial benefit from entering into a supervisory agreement with a PA. These conditions put PAs at a disadvantage to NPs in the healthcare marketplace, resulting in lost jobs and opportunities for advancement. View infographic at AAPA.org/obstacles. How does OTP differ from independent practice? Team-based practice is the hallmark of the PA profession and its educational programs. Under OTP, PAs will continue to collaborate with physicians and other qualified medical professionals, as indicated by the patient’s condition and the standard of care, and in accordance with the PA’s education, training and experience. The term “independent practice” suggests that PAs would abandon team-based care and would work without the benefit of collaboration with physicians or other providers. How will OTP benefit patients? Numerous studies have shown that PAs provide high-quality patient care and are cost-effective medical providers. Once OTP is incorporated in state law, it will expand access to care, especially in medically underserved and rural areas, expedite PA licensing, and give PAs a greater ability to provide volunteer medical services such as responding to disasters. In addition, the elimination of the requirement to have a supervisory agreement with a physician will free up physicians’ time to focus on meeting patient needs rather than filling out burdensome paperwork.

Now that OTP has been adopted as AAPA policy, what happens next? Each state PA chapter can decide whether or when to pursue these changes at its own pace and as the situation in their state legislature allows. For more information, please contact Carrie Munk, vice president of communications, at cmunk@aapa.org, (571) 319-3047.