PA History Transformed. I'm Proud, Amazed and Ready.

The AAPA House of Delegates had debated the “Optimal Team Practice” resolution long enough…..it was time to vote. But before we finish, some background.....

This one was huge. It would give the AAPAs blessing for the PA profession to have responsibility to practice being responsible for our own profession. something that all professions have. Yes, all professions. Something that our NP colleagues have as RNs, but in many states not as NPs. Something that worried some. Independence is a foolish word. We don’t want to leave the team, but we want to be fully responsible members of that team. No one practices alone anymore, but people are responsible for what they do. PAs (and NPs) always have had the option to practice alone with physicians 20 or 100 miles away. This was different. All I (we) wanted is responsibility for what I did every day. All I wanted was to own my own profession. Sign my name say goodbye to everyone at work and go home. End the barriers. Permission to end a part of history that placed unfair barriers on myself and my profession.

Our House of Delegates is a site to see. We were in Mandalay Bay in Las Vegas. Over 7,000 PAs attending the conference and only a select few representing the entire profession at the House. I am sure most delegates would have rather been at the pool. But there they were anyway, in this huge room, committed to debating and voting on all of the resolutions. Many of them giving testimony, all very politely, all very transparently. Not on one issue, but THIS was the issue. No one pushing against us except history. Ghosts of PAs past, and ghosts of PAs future hovered all around us. History was in the room. You hardly see that anymore, but I saw all of the ghosts. That's what happens when you are a PA leader for 40 plus years. All of us trying very hard to represent our views. Some totally ready, some ready but worried about what “other stakeholders" or those ghosts would think, and some were open to hearing both sides.

Optimal Team Practice (OTP) is what the AAPA Task Force called the changes that would set up the new modernization of PA practice. It keeps PAs part of the team with our NP and MD colleagues. It started out as “Full Practice Authority and Responsibility” (FPAR) and in theory did not change much. It means a few things; all which most of my militant PA and NP colleagues would agree with. Full practice (no regulatory supervision/collaboration), PA regulatory state Boards (now we have medical Boards that in some cases don't know much about us), universal insurance reimbursement to the PA and more. If passed this would be as large as a shift as the PA profession had ever undertaken. But the “ask” was not at all being done easily or haphazardly. There were guidelines from a very well led Task Force and hopefully they would be endorsed by the HOD so that states who wanted to modernize could use them if they chose to change their state practice acts. Its need was brought on by so many factors; the maturation of the PA profession itself and the ability to compete with other healthcare professionals who had taken responsibility for what they did in the marketplace. Not just NPs, but others like pharmacists and physical therapists who now own a scope of practice that PAs (and many NPs) still do not. Time was passing us by. This had less to do with going out to own our own practices and more to do with maturation. Lets face it, PAs could always could practice autonomously. This had more to do with just plain taking full responsibility for what we did. You do something and you sign your name. Period. Not needing a “collaborative” or “supervising” physician years after we started to practice. It also had so much to do with how medicine is changing. Physicians were no longer employers but employees. They wanted to work with clinicians who would give them the least liability and be able to be colleagues with people whose regulations would not hassle them or increase their liability. This responsibility and the fact that so many more physicians were working as employees gave administrators a reason to stop an increasing number of PAs from being hired. The changes we sought were not born out of a need to leave the team; hence the "Optimal Team” part, but would allow the PA to practice without MANDATORY regulatory supervision or collaboration. How we all practiced would be dictated by clinical knowledge shown at the practice level, just as it is for all other professionals. Basically the same regulations as every other profession has for itself. 

The AAPA had put together a Task Force with a Chair who was as fair and balanced as anyone could want. After many months, they came back with well thought out recommendations. Some PAs were worried. A survey was done of the entire profession and OTP/full practice was preferred in each state. Still people were worried. Change is hard. It is also scary. PA culture, is, by our very nature, not used to sudden change. At a minimum, change would have to be explained to all stakeholders including physicians, and some of those would not be happy. Still, in our last elections every candidate who ran, every one, endorsed the Task Force’s recommendations. We were ready. 

So back to the top…..Our House of Delegates (HOD) had been debating these changes for parts of 2 days. Some wanted a particular sentence or word struck, some felt that other changes were in order. The clock was ticking and we knew that compromises would have to be made. All of a sudden, on day two, compromise happened quite quickly. Just when it looked to some that the process would be drawn out, possibly with each delegate individually having to have a roll call vote, the PA Educational Association (PAEA) announced that if a few changes were made they could compromise and support the resolution. Most of us “progressives” gasped. Could it be that the inevitable would happen? Seriously? I, for one, was shocked. 

The "question" was called and within a five minute period the future of the PA profession and it’s paradigm was changed forever. A shift many never thought they would see for years, came to pass. And it was passed. Yes, we had it. Yes we did it. ALL OF US. OK, again...ALL OF US. Yes, in a profession that hardly agrees with anything, we knew the time had come. DONE. Most of all the rank and file delegates sent to represent their fellow PAs from every part of the USA took their commitment to further the profession as seriously as I had ever seen it taken. I was totally and seriously impressed. 

The course of PA history had changed forever. Yes, me, Dave, the PA who had written more about “full practice" for PAs than almost anyone else in our profession’s history was speechless. One who was a leader and who pleaded with my colleagues that these changes were needed to successfully evolve.....speechless Yes, that Dave…. All my arguments had vanished. "We” were validated. Us and “you” had become one. The people who did not understand, understood. The magic of compromise. I doubted my reality.

Everyone turned to hug each other. Not ten, not twenty, but hundreds. The Task Force, the House, the Board, each and every Delegate, the educators, staff, others…. knew and felt at that moment that we had made history. It was palpable. A “Where were you when you heard?” moment. I could not process much that went on. All I did was cry and hug anyone I saw who responded to my outstretched arms. I was in shock. I still am. I can compare my feelings to something else that happened to me 27 years ago, and then again three years later. I felt the same way when I held my son and later my daughter in my arms for the first time. I was exhilarated. I was scared. I was amazed. I was immobile. I was filled with emotion. I was totally at peace. I knew my life had changed for the better and it would never be the same again. I knew there would be changes in it that I could not predict, but I knew that this was the way we needed to go. That at the end of the day this felt so right, so good, so good for our patients, so good for access, cost, everything. I know we are up to the task. 

Interestingly, I awoke two days later with another realization. This will empower us in a way we never knew before. I am a PA leader that is “aging”. Most of my colleagues had never felt this way before. I had felt this feeling a number of times in the distant past, but not over the last almost three decades. My NP colleagues had. I am sure my physician colleagues had. We PAs, or at least this PA, had not for decades. Not like this. Not this deep. I was at Woodstock and for me this beat it. This date was history. I might be over reacting but I don’t think so. My two other past recollections were close but still not this good; NY State passing the prescribing law in 1976 (yes, we could not prescribe legally before that) and being a former medic, PA commissioning in the Air Force in 1990. For me, both changed my life but this is more than that.

I salute the AAPA and every delegate who knew it was time. Every delegate who would not take “no” for an answer is now my hero. Every grassroots PA who supported them, I owe you one. The Full Practice Task Force” who came up with the recommendations that led to this historic vote-your pictures are on my wall. The AAPA staff, our state leaders, PAFT, AFPPA, and all of our colleagues who led us to this path; thank you. And yes, that also includes the NP profession who showed us it could be done and some of our our physician colleagues who have always supported us being more. It takes a profession and a village. 

So where am I now? Still making no footprints (walking on air). Wow, just wow. I need more time to process. I am holding my profession in my arms, scared to let go, but knowing that I have to; just as I have so many times before. Time to give the kid the car keys and let her go. Just call me every 15 minutes or so to check in. There are 50 states to drive through. 

I am so proud of us all.

I am amazed. I am ready. 

Wow.

Dave

The above views are those of the author only and do not represent Clinician 1 or any Board that the author may belong to, or be part of.