Optimal Team Practice Tops the Agenda at Education Forum

Optimal team practice (OTP) was a major topic of discussion at the 2017 PAEA Education Forum. A Four-Org panel discussion, a structured discussion at each of the retreats, a standing room-only educational session, and a motion at the Business Meeting provided plenty of opportunities for information to be shared and voices to be heard.

The next step for PAEA will be to put together the task force requested by the business meeting motion, a group that that will include representation from “all appropriate stakeholders,” to “address the implications of OTP for PA education and for new graduates as raised in the 2017 PAEA OTP Task Force Report and report back to this body by next year with the findings.”

“We recognize that OTP is likely to be the practice environment that many of our graduates will enter in the future, and we want to work with our colleagues to be sure that the implications of OTP for PA education are fully considered as this policy is implemented,” said PAEA CEO Timi Agar Barwick.

Four-Org Panel Discussion

The CEOs and chief elected officers of each of the Four Orgs — AAPA, NCCPA, ARC-PA, and PAEA — took the stage at the Forum for a moderated panel discussion on OTP, the first time in recent memory that all four PA organizations participated in this kind of debate. Barwick kicked off the session with her keynote address, “What Got Us Here Won’t Get Us There,” a reflection on the changes that the Association will need to make as it shapes its future in an uncertain world. Questions for the panel were supplied by PAEA member programs.

Much of the panel discussion centered on the different perspectives regarding the need for changes in PA education in response to OTP. AAPA’s position is that no changes in PA education are currently necessary, and that practice-level onboarding will prepare new graduates for a practice environment in which there are no longer state law requirements for PAs to have a specific relationship with a physician in order to practice.

While generally supportive of OTP, PAEA leaders expressed concerns that the effects of OTP on PA education were not yet fully understood. “We have a lot of hands on the elephant, and we are still trying to understand it. It is essential that AAPA provide clear language that describes the expected clinical relationship between PAs and physicians,” said PAEA President William Kohlhepp.

Other issues discussed in the debate were the market-driven impetus for OTP, especially competition for jobs with nurse practitioners; the possibility of a PA clinical doctorate; the changing requirements of employers; and the potential effect of OTP on the PA-physician relationship.

Perhaps the biggest takeaway from the debate was that more discussion is needed among the Four Orgs. “We need to continue this conversation,” said NCCPA President Dawn Morton-Rias. “This is not one and done. We need to remember we are representing the entire profession and for the betterment of our profession and the health care community.” To that end, the Four Organizations held a one-day meeting immediately following the Forum and dedicated part of the agenda to OTP.

A Quick Refresher on OTP

OTP is a new policy passed by the AAPA House of Delegates in May 2017 that allows its state chapters to seek changes in state laws that will, among other things, eliminate the legal requirement for PAs to have a specific relationship with a particular collaborating physician in order to practice. For more information on AAPA’s perspective on OTP, visit the AAPA website.

PAEA supported three of the four elements of the OTP resolution: team practice, autonomous state boards, and direct reimbursement for PAs. PAEA did not initially support the elimination of the specific relationship with a physician, due to language that raised concerns that OTP was fundamentally describing a very different clinical relationship between PAs and physicians and therefore had implications  for new graduates and  for PA education. (See Networker coverage of the HOD meeting.)

“PA education is built around curricula that prepares graduates to practice medicine with physician collaboration,” Kohlhepp stated in his testimony to the House. “If PA programs are to produce graduates to practice with full practice authority, we will need to educate them differently.”

PAEA leaders initially spoke against the resolution at the HOD, but ultimately supported the final version, following a change to the language that reaffirmed that “the manner in which PAs and physicians work together should be determined at the practice level.”

PAEA’s position was informed by the work of the Association’s OTP Task Force, whose report can be found here.