We celebrated a most important American holiday this month, Independence Day. On July 4th, the Continental Congress formally adopted the Declaration of Independence, which had been written largely by Thomas Jefferson. On this day the thirteen original colonies declared their independence from British Rule and took upon themselves the burden of self-government and how to make it palatable to all of its citizens.
When I reflect on independence, I consider total autonomy and expanded utilization of a profession comes to mind. I also think of the mechanics; who is involved and how they differ from others. What distinguishes an individual? Truth, honesty, enthusiasm, consistency… and lastly – their reputation among their peers. What defines a leader? The same set of words with the addition of experience and a willingness to learn. What distinguishes a politician? Ideally, the same criteria with the addition of good judgement, a solid support staff and a lack of bias towards any group of people, nationality, color, creed or immigration history. We are a nation of immigrants with a history of “taking the world’s huddled masses”, as inscribed on our Statue of Liberty. What distinguishes a religious leader? People like Dr. Martin Luther King, Jr. and Billy Graham who had a message that was defined by love. And now I ask, what distinguishes a profession?
When thinking of a profession, I think of individuals who have acquired higher academic degrees with targeted focus on their specialized area of expertise. They come from all backgrounds but are dedicated to excellence and improving the human experience. When I think of medicine and nursing, I consider physicians, scientists, technologists, nurses, nursing assistants, EMTs, as well as the physician’s counterpart, the PA and the NP. I use the word “counterpart” because PAs and NPs are trained in most of the same areas as a physician and have learned the diagnostic criteria necessary to perform an examination and order laboratory studies and necessary radiographic tests. After a diagnosis, they formulate a treatment plan, write the appropriate prescriptions or preventative medicine alternatives. All of these providers depend on their experience and use judgement to bring in a specialist to achieve optimal care. The expression “optimal care” is not to say that any individual practitioner can achieve this by themselves. We flourish as members of a team who can access a referral network of experts when their patient has a disease that falls out of your area of expertise.
New legislation is being established around the country which is gradually granting PAs and NPs Expanded Practice Authority. “On May 29, Minnesota PAs ended the legislative session with a long-sought victory that improves employment opportunities for PAs and expands patient access to healthcare. This legislation was signed into law by Governor Tim Walz on May 27, 2020. The bill removes references to supervision, delegation and physician responsibility for care provided by PAs, allowing them to practice to the full extent of their education, training and experience. It also allows PAs to prescribe on their own qualifications. The new law allows PAs in Minnesota to be regulated with similar standards of NPs.” (AAPA.org). This is a boon for PAs, patients and physicians, who in the past were responsible for all PA actions and treatments.
I was recently perusing NP House Calls on Facebook and its founder, Ann Kriebal-Gasparro, posted the following NP SmartBrief:
Investigators studied the impact of expanded state scope of practice (SOP) laws for NPs and PAs on primary care utilization by NP, PA, and primary care physicians (PCP) in community health centers. During the study, 12 states liberalized NP SOP laws. Results showed that granting independent practice and prescriptive authority for NPs resulted in statistically significant increases in NP visits, and decreases in both PA and PCP visits, for those CHCs with a high proportion of NPs and PAs. As the NP and PA workforce continues to grow, and as SOP laws continue to be liberalized, it is important to advance evidence on how to most efficiently deploy providers.
Source: Park, J., Han, X, and Pittman, P. “Does expanded state scope of practice for nurse practitioners and physician assistants increase primary care utilization in community health centers?” Journal of the American Association of Nurse Practitioners. Vol. 32, No. 6 (6/17/2020 Increasing Scope of Practice Will Increase Utilization of NPs in Primary Care).
What is the significance? Expansion of privileges increases our visibility and utilization. Full Practice Authority is the NP law in 23 states. This expansion allows the public to be seen by an NP. Some patients may feel more comfortable with their NP or have the perception that NPs spend more time or may be able to book appointment sooner than their physician. Full practice authority has been the central component of NPs superb legislative agenda and is actively supported by most of the NP population. As long as PAs in most states do not have Optimal Team Practice or Full Practice Authority, they will lag behind their NP counterparts. The message for PAs is to study Minnesota and to work in large numbers on a state level to achieve the same outcome.
I spoke of independence and expanded utilization of a profession; what distinguishes a person, a leader and the new responsibilities that come with independence – just as it was for our country’s earliest settlers. It takes planning and working together with passion to achieve a goal. It speaks of new responsibilities and uncharted land when it comes to a nation or a profession. As PAs move towards greater independence, broader horizons and responsibility, now more than ever before, they need to be aware of the challenges and potential liabilities when a physician is no longer responsible for the patient.
Now is the time to consider your malpractice or personal liability exposure – and a policy to protect and defend your interests alone. This should be your own personal professional liability insurance policy, covering and defending your professional responsibilities. This is as important as being licensed to practice, as this policy protects your personal and financial freedom to fulfill your calling.
By Robert M. Blumm, PA, DFAAPA, PA-C Emeritus
PA Advisor to CM&F