Q&A with Beth Smolko, President and Chair of the AAPA Board of Directors
Legislative Action, TCI, DEI, Five-Year Strategic Plan on Agenda
September 5, 2020
AAPA’s new President and Chair of the Board, Beth Smolko, DMSc, MMS, PA-C, is the founding program director and department chair for Frostburg State University’s PA Medicine Program in rural western Maryland. The program was created specifically to address the need for increased access to healthcare in Appalachia, as well as medically underserved areas across the country. Smolko’s passion for accessible, effective, and compassionate patient care led her to found the nonprofit The Heart of Medicine, dedicated to delivering primary care to poor and underserved communities in Haiti. Prior to her current position at Frostburg, Smolko served in the unique position of lead clinical advisor and telemedicine lead for Wellness Center Operations for Lockheed Martin, the largest defense contractor in the world.
Q: How has the PA profession responded to the COVID-19 pandemic?
A: Let me start by saying on behalf of the entire AAPA Board of Directors, thank you to all PAs for their incredible work in response to COVID-19. So many of our members have been on the frontlines, first-hand witnesses to the horrors of this pandemic, working in war-zone conditions and making incredibly difficult decisions. For more than 180 days, this profession has suited up, stepped out and shown up to care for patients, despite PPE shortages and personal risks to their own health and that of their families, their children. This is service, this is compassionate care, and this is the character of the PA profession.
The COVID-19 pandemic has demonstrated that laws and regulations MUST support a PA’s ability to adapt and pivot to where and when healthcare need exists. This adaptability is the hallmark of our training – as medical generalists treating the whole patient – and it uniquely positions us to flex to the needs of our patients and the healthcare community. Never in my lifetime have those needs been more pronounced than during this global pandemic, when an already fragile and fragmented healthcare system is over-stressed.
So how will the PA profession move forward? We will redouble our commitment – as individual PAs and as an organization – to advocate for legislative changes that make permanent temporary waivers put in place by governors in response to an emergency need. If we can increase access to quality care under the adversity of a crisis, we can certainly provide the same quality care under normal circumstances.
During our summer AAPA Board of Directors meeting, we considered opportunities where PAs could lead during the pandemic. One significant role for PAs, here and now, relates to the next emerging public health crisis: the confluence of a resurgence in COVID and seasonal flu this fall. This year, AAPA has designated October 12, the last day of PA Week, as a day to rally PAs around the importance of vaccines. Our goal is for PAs to encourage patients to get their immunizations up to date for vaccine-preventable diseases, and to get their flu shots. While the overall theme of PA Week is “PAs are Essential,” we want PAs to lead the charge to remind patients that vaccines are essential.
Q: What legislative changes will the profession be seeking in the upcoming year?
A: As I mentioned, COVID-19 has demonstrated to the healthcare community and the world that all laws and regulations must support PAs’ ability to adapt and pivot where we are needed most. Temporary executive orders by state governors removed barriers that gave PAs more flexibility during this crisis. But in some places, existing laws and regulations prevented PAs from contributing even more to the response. These temporary waivers must become permanent and these existing barriers must be removed from state legislation and regulation.
PA practice should not be contingent on our relationship to or association with any other provider. PAs must be responsible for the care they provide. Additionally, states should have separate majority PA boards, or have PAs or physicians that work with PAs represented on medical or healing arts boards that regulate PAs. Like physicians and nurses, we should regulate our own profession because we know how PAs practice medicine.
And finally, PAs should be eligible for direct payment by public and private insurers. Currently, PAs are the only health professionals who are authorized to bill Medicare for their services but are not able to receive direct payment. Medicare permits all health professionals—physicians, advanced practice registered nurses (APRNs), physical therapists, psychologists, podiatrists, social workers, and others—to receive direct payment under their own name and National Provider Identifier number. We continue to aggressively pursue this legislation in Congress.
Additionally, COVID-19 has created a surge in telemedicine. It is increasingly how patients access healthcare, especially in the midst of a pandemic, since it can be a safe gateway to determining who needs the next level of care. We are working diligently to remove barriers such as licensure and reimbursement, so that PAs can fully participate in this healthcare delivery modality. Among our current partners is the Center for Telehealth & E-Health Law, or CTel. This “go-to” legal and regulatory telehealth organization brings together researchers, large telehealth employers, and healthcare providers. CTel is highly regarded for their data-driven approach to telemedicine legislation. I am honored to be serving on their Advisory Board so that the PA voice is represented during critical conversations.
Q: What can individual PAs do to move our legislative priorities forward?
A: While AAPA continues to work strategically and tirelessly on these state and federal efforts, I challenge every PA to join us in advocating for your profession. Too often, advocacy is left to a handful of leaders, but they alone cannot make the changes we must have for our profession to compete in the marketplace and thrive. Legislators want to hear from their constituents, not just paid lobbyists. PAs have stories to share that bring to life key issues that legislators need to hear and understand. Personal stories portraying your experience with patients are powerful tools that can move legislators to action. I am imploring each and every one of you to take action because every letter, every email, every phone call, every PA present at the state capitol amplifies our voice by one more, and these single actions add up to make us a powerful force to effect change.
Q: What is AAPA doing to address issues of diversity, equity, and inclusion within the healthcare system?
A: As providers, we must continue to look at the root causes that affect population health. We must integrate social determinants into our patients’ treatment plans, improve health literacy, and direct patients to resources and services so that they can be effective advocates for their own health.
AAPA is supporting these efforts by developing CME to educate PAs about health disparities.
In addition to this, the intersection of COVID-19 and social unrest have led AAPA to reflect and evaluate how we—as a healthcare profession—can better address diversity, equity, and inclusion within the healthcare system, and within the PA profession. This is a difficult undertaking and one which merits thoughtful, methodical, and sustained work and collaboration.
In June, AAPA hosted two listening sessions to hear from Black PAs and PAs of color about their experiences with racism and their ideas for solutions. Some themes from those sessions include mentorship programs for people of color at all stages of their careers, and pipeline programs to recruit more diverse PA-school candidates.
In July, the PA Foundation established the Joyce Nichols Memorial scholarship for Black PA students. And at its July meeting, the AAPA Board of Directors established a Diversity, Equity, and Inclusion Commission, and an under-represented minority leaders fellowship. Both Board initiatives are in their nascent stages, but they demonstrate the Board’s commitment to DEI where we can effect change—within the profession and the healthcare system.
Q: What is the status of the Title Change Investigation?
A: We have found that this work goes far beyond the PA title. It must also look at the PA brand and how our profession fits into the healthcare marketplace. WPP, the research, branding, and communications company hired to investigate the creation of a new professional title, has recently gained impressions of title options through research with physicians, employers, and patients. They have used all of this information in their final analysis.
The PA Title Change Investigation final presentations from WPP, our legal counsel, and AAPA will occur during the virtual House of Delegates Meeting on November 20. More information will be forthcoming soon, so please continue to check the TCI page on AAPA’s website.
We all live the PA brand. So even if our title is misaligned, we must be brand ambassadors. I know many PAs are sometimes mistaken for either physicians, nurses, or even medical assistants. It is my hope that the data and findings revealed through the Title Change Investigation will help change this paradigm so that patients and legislators know and understand what we do and how we serve our patients.
Q: What’s next for the PA profession?
A: The aftereffects that COVID-19 will have on the healthcare system — and on the health of our patients — are a challenge that will soon be put upon us. It will affect not only our older patients, but younger generations, too, whom current and future PAs will be treating for years to come. At the moment, we are focused on the here and now. But at some point, we will be on the other side of this pandemic.
We are currently working on our next five-year strategic plan, which will be rolled out during the first quarter of 2021. Underpinning our work is keeping PAs at the forefront of healthcare, competitive in the marketplace, and able to practice to the top of their education, training, and experience.
Q: Do you have any closing thoughts to share with our members?
A: I would like to end where I started, by thanking all PAs for the incredible quality care they are delivering every day to our patients. While COVID-19 remains a daily threat, I know it can be hard to think too far into the future. But I want you to know that AAPA is standing with you and fighting for you—on Capitol Hill and with your state organizations in state legislatures across the country.
As healthcare providers, we know that it’s likely going to get harder before it gets better. We’re going to continue to be challenged and pushed to do more. But as a dear PA friend and leader always reminds me: We are PAs and PAs do hard things.
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