Integration of PAs into the VA's Health Care Workforce

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April 14, 2008

 

The Honorable James B. Peake, M.D.

Secretary, U.S. Department of

   Veterans Affairs

Room 1000

810 Vermont Avenue, NW

Washington, DC  20420

 

Dear Secretary Peake:

 

On behalf of the more than 68,000 clinically practicing physician assistants (PAs)  represented by the American Academy of Physician Assistants (AAPA), I am writing to encourage the Department of Veterans Affairs to more fully integrate physician assistants into the VA’s health care workforce. Specifically, I request that –

• PAs be allowed to compete for employment opportunities that are advertized for nurse practitioners in VA medical facilities, particularly PAs who are veterans;
• the VA categorize the PA profession as a critical occupation and expand the VA locality pay system to include PAs, so that PA employment and salaries are regularly tracked and reported by the VA; and
• the Department support enactment of HR 2790, legislation to establish a full-time Director of PA Services located in the VA Central Office.

 

PA Employment Opportunities in the VA

 

As you are aware, PAs in the Army and other branches of the Armed Services play a critically important role in providing immediate medical care to wounded soldiers who are serving our nation through Operation Enduring Freedom and Operation Iraqi Freedom. Regrettably, the AAPA continues to hear anecdotal stories that PAs, including those who have returned from deployment in Iraq and Afghanistan, are not eligible to apply for health care positions in VA medical facilities. If this is the case, the PA veterans are not being granted preferential employment status by the federal government, and the VA medical facilities are not utilizing the quality medical care offered by PAs. Recent advertizing by the VA in the February 2008 Clinical Advisor, a periodical for physician assistants and nurse practitioners, appears to support this concern. A full-page ad was placed in the periodical for VISN 12 medical facilities, entitled “Nurse Practitioner Opportunities.” Only one of the 25 vacancies posted in the ad referenced an opportunity for a physician assistant to work in surgical performance measures. Some of the positions specifically targeted for nurse practitioners in the ads were “General Outpatient Medicine, GU Clinic, ENT Clinic, Vascular Surgery, Medicine/Cardiology, and Primary Care” – all of which are areas of medicine in which PAs practice.

 

The AAPA supports the goal of a seamless transition of medical care from the Department of Defense to the Department to Veterans Affairs and believes that PAs are an underutilized resource in the transition from active duty to veterans’ health care. As health care professionals with a longstanding history of providing care in medically underserved communities, AAPA believes that PAs may also provide an invaluable link in enabling veterans who live in underserved communities to receive timely access to quality medical care.

VA Recruitment and Retention of PAs

 

In its January 2008 written testimony to the Health Subcommittee of the House Committee on Veterans Affairs, the AAPA stated that it was not aware of any recruitment and retention efforts aimed towards employment of physician assistants in the VA. We believe that no efforts are made, because the PA profession, unlike physician, nurses, and some other health care professions, is not designated as a critical occupation in the VA. Additionally, PAs are not included in any of the VA special locality pay bands, so PA salaries are not regularly tracked and reported by the VA. We’ve been told that this has resulted in lower pay for PAs employed by the VA than for health care professionals who perform similar medical care. We have also been informed that the current method of tracking recruitment and retention is through VISN succession planning reports. PA recruitment and retention difficulties are often masked by the fact that advanced practice nurses can be hired when there are a lack of PA applicants for mid-level provider positions. Accordingly, we ask that PAs be considered a critical occupation within the VA and that PA employment and salaries be tracked within the VA health care system.

VA Support for HR 2790

 

AAPA believes that enactment of HR 2790 is essential to improving patient care for our nation’s veterans, ensuring that the 1,600 PAs employed by the VA are fully utilized and removing unnecessary restrictions on the ability of PAs to provide medical care in VA facilities. PAs are fully integrated into most public and private health care systems. As you are aware, each branch of the Armed Services designates a PA Consultant to the Surgeon General. Many major medical institutions credit the integration of PAs in the workforce to a Director of PA Services. To name just a few, the Cleveland Clinic, the Mayo Clinic, the University of Texas MD Anderson Cancer Center, and New Orleans’ Ochsner Clinic Foundation all have Directors of PA Services. The Academy believes that what works for the Armed Services and the private sector will also work for the VA.

The AAPA congratulates you on your appointment as Secretary of the Department of Veterans Affairs and looks forward to working with you. I would be most happy to meet with you to further discuss utilization of PAs in the VA health care workforce. Please don’t hesitate to have one of your staff contact Sandy Harding, AAPA’s Director of Federal Affairs, at 703/836-2272, extension 3205, to arrange a meeting.

 

I look forward to hearing from you.

 

Sincerely,

William F. Leinweber

Executive Vice President, Chief Executive Officer