House of Delegates Rejects Changes to OTP, Proposes Investigating Title Change for the Profession

At the AAPA Conference in New Orleans this week, the House of Delegates (HOD) rejected proposed changes to the policy of optimal team practice (OTP) that was adopted at last year’s HOD meeting, following extended discussion of the definition and implications of OTP. PAEA President Lisa Mustone Alexander, EdD, MPH, PA-C, testified in favor of a resolution from the Ohio, Texas, and Virginia chapters that was intended to ameliorate concerns expressed by the American Medical Association (AMA) that OTP represents a move toward independent practice by PAs.

While we support most elements of OTP, PAEA is concerned that the perception by the AMA and other physician organizations that PAs are moving toward independent practice — whether or not this was the intent of the OTP policy — risks alienating our physician preceptor colleagues, thereby worsening the shortage of clinical training sites that many programs are facing. The resolution would have added language to the OTP policy specifying that, under OTP, PAs would continue “collaborating and consulting” with physicians and other members of the health care team, even though no legal relationship with a physician would be required in state law – a key tenet of the policy.

In a related resolution, the House voted to ask the AAPA Board of Directors to contract with a consulting firm to investigate options and legal implications for a new professional title for the PA profession. The “physician assistant” title, according to the resolution’s rationale, is a barrier to full understanding of the PA role by payors, legislators, health care administrators, physicians, and patients, and contributes to the “lack of proper reimbursement for PA services, inappropriate delegation, and/or underutilization of PA services.”

Alexander, along with the leaders of the other national PA organizations, testified that all of the Four Orgs should be included on the body selected to move this project forward, stating that “a significant change to the profession like this should have the broadest possible input.” The results of this investigation will be reported back to the 2019 HOD next year in Denver.

Other adopted resolutions with a PA education angle expressed AAPA support for (1) parity of the PA profession with other health professions in federal loan limits for students, (2) increased federal funding for Historically Black Colleges and Universities, Predominantly Black Institutions, Hispanic-Serving Institutions, and rural serving institutions, and (3) eligibility for federal and state funding by PAs attending postgraduate programs.

The House also referred a resolution supporting ARC-PA Accreditation Standards requiring PA programs to provide at least 80 percent of didactic instruction face-to-face rather than online. This resolution engendered considerable discussion, much of it concerning the lack of evidence that online education is less effective than face-to-face education in producing well-trained PAs. Referral of the resolution means that the House Officers will determine an appropriate body to consider the issue before the next HOD meeting.

Alexander briefly addressed the delegates during the series of reports at the beginning of the meeting. She thanked AAPA for the opportunity for PAEA to be part of the important conversations facing the profession and brought attendees up to date on the Core Competencies for New Physician Assistant Graduates, due to be released in the next few weeks, and PAEA’s work with the ARC-PA on outcomes-based accreditation. She also asked PA faculty members and preceptors – a significant percentage of the delegates, as it turned out – to stand and be recognized, thanking them for their service to PA education.

The PAEA delegation attends the annual HOD meeting in an observer status, testifying on some resolutions pertinent to PA education and responding to questions from the floor, but not voting.

Correction (6/4/18): This article was updated to reflect the addition of Predominantly Black Institutions and rural serving institutions to the final resolution language regarding support for increased federal funding for these institutions.