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Quote of the Week
"Our nation's dysfunctional health care system negatively affects all of us, everywhere, all of the time," says David Dyjack, Dr.PH, CIH, Dean of the Loma Linda University School of Public Health.
Well then.
Dr. Dyjack is one of the organizers of the Southern California Health Care Summit to be held in Ontario (Southern California, not Canada) on October 29. The summit's mission is to "identify solutions to providing the highest quality health and health care to as many people as possible." The California Academy of PAs is a summit sponsor.
Reform Ready State Law
Here is a question that's on everyone's mind: If we have a reformed health care system, who will care for the newly-covered?
Well, PAs, and particularly if the state law allows physician assistants to practice without arbitrary barriers to full efficiency. A Minnesota study that addressed this very issue called for states to allow health professionals to be able to practice "at the top of their license."
The Six Key Elements of a Modern PA Law describe "top of the license" for PAs. Currently, only Rhode Island law incorporates all six Key Elements. But Alaska, Maine, Minnesota, Michigan, New Mexico, North Carolina, South Dakota, and Wyoming laws incorporate five of the six key elements. (Note: Maine and New Mexico would have all six if the osteopathic board laws and regs matched those of the medical board.)
What percent of jurisdictions contain each of the Key Elements? Here's the snapshot:
"Licensure" as the regulatory term for PAs: 90.2%Full prescriptive authority: 68.6%
Scope of practice determined at the practice site: 54.9%
No chart co-signature requirement in the law: 35.3%
Adaptable supervision language: 31.4%
No ratio restriction: 13.7%
Along with the Six Key Elements, ideally states should have a logical licensure system that allows any licensed PA to be supervised by any licensed physician if both agree to the arrangement and a document outlining the agreement, the PA's delegated scope of practice, and the supervision mechanism is kept on file at the practice. This system allows for a ready response to the changing needs of all populations, systems, and specialties.
Ready to advocate for a change in your state? Help from the Academy is just a click away.
If Only Good Language Travelled as Fast...
A recent change in Wyoming PA law that authorizes the medical board to allow a greater number of PAs to be supervised by a physician set the regulation promulgation machine in motion. Academy staff monitors regulatory changes and was admiring the newly enacted law and proposed regs until...
Section 20 showed up. The new section sought to impose a brand new co-signature requirement, something not contemplated by the statute. Academy staff notified Wyoming PA leaders, who were just as shocked.
The new section looked familiar. Upon further scrutiny it became clear that the new Wyoming requirement was an existing Colorado requirement that had crawled right up I-25 from Denver to Cheyenne.
The Wyoming PAs said, "No, thank you." Working with the AAPA, Wyoming PA leaders sent testimony and met with the medical board to describe why such drastic measures were absolutely contraindicated in a state where no problems existed to be solved, and the paucity of providers and absence of training programs requires laws and regulations that invite and allow physician-PA teams to customize and strategize to see that patients are cared for.
The medical board said, "Point taken." The proposed requirement was withdrawn.
The moral of the story? Sometimes you change a law because it is good for health care in your state. But you should also repeal dysfunctional requirements so they don't grow legs.
Report from the Undeterred
The Florida PA leadership has made a sustained effort to develop an effective relationship with the Florida Medical Association (FMA). Some years the PAs made progress, some years not so much.
But this year the door has swung open. Florida PA leaders have enjoyed a cordial reception and substantive discussions with the medical society leaders and staff. There is talk of adding a PA representative to the FMA Board of Governors.
If your state has yet to develop an effective relationship with key organizations in your state, take a page from the Florida playbook. Things can change. Elected leadership and staff of partner or potential partner organizations evolve. Organizational priorities are amended. Keep after it. Don't let a history of negative responses deter you. If you don't ask, the answer is always "No."
For tips for developing or improving relationships with state stakeholder organizations, see Team Building, the Academy's handbook on creating effective organizational relationships.
Planning Ahead
Utah legislative leadership reports plans to support legislation to amend awkward language governing student practice, add an additional PA seat to the physician assistant regulatory agency, and double the number of PAs that a physician may supervise. North Dakota reports draft rules to improve or repeal the current ratio restriction. California and Arkansas are planning to support a repeal of requirements that the physician's name accompany the PA's name on prescriptions (because that does not work at all in many electronic Rx systems).
The Ratio Report
Although only 13.7% of states have no ratio restriction at all, there is lots of activity on this axis. In the past three years nine states have improved or repealed a ratio restriction in law or regulation and eight state chapters are in the planning phase for supporting a future change. Read more about ratios in this issue brief.
Legislative Watch is a monthly state government newsletter written by Ann Davis, PA-C, AAPA director of state government advocacy and outreach (
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; 530-272-9655). LW is sent to national leaders, PA program directors, PAs who serve as members of state regulatory agencies, and AAPA constituent organization leaders (please recognize that as an extremely subtle reminder to make sure that the Academy has your correct chapter leadership info, especially if you changed leadership in July). It is also sent to "interested others," so feel free to recommend or become one of those. Newsletter editors may reprint non-sensitive items if you credit the source using its full name: The American Academy of Physician Assistants' Legislative Watch.
