Result of quiz at the bottom of the article.

The PA Title: Assistant or Associate

     It's not a matter of pettiness or pride. The title has been one of controversy likely since its genesis in 1965. Physician Assistant, often miswritten as Physician's Assistant, has long been inadequate in reflecting the scope of practice and ownership of patient care that so many PA's have.  There are basically two categories current or future PAs fall into; 1. The name MUST change or 2. This is a waste of time, who cares! I will admit that initially, I didn't really care at all as long as I had SOME title after all this school. Now, as I near graduation at the end of next week, I have contemplated the impact that a title change may have on the profession overall. The heavyweight bout seems to be between NPs and PAs, pitting one another against each other. I'd argue that both have their place in patient care. There is no winner in here; collaboration is the best solution as long as high-quality patient care is maintained. 

      PAs have unfortunately fallen victim to poorly defined roles between the individual states impacting their relationships with supervising physician's, billing companies, and their patient's. There have also been some serious disconnects between the different PA organizations. The National Commission on the Certification of Physician Assistant's (NCCPA) and The American Academy of PAs (AAPA) went head to head in 2017 regarding specific changes that would have allowed greater access to care for patients and afforded improved practice and prescription authority to PAs in West Virginia. NCCPA had lobbied against the efforts made by AAPA in what seems like a scheme to make more money by tying NCCPA certification to licensure (that article here). This is worrisome to me as it seems that in a profession so new and rapidly changing, it is essential to have a unified front concerning the message and goals for a path forward.  I have made it a point throughout my training thus far to poll the people I have come across as to their thoughts on the matter. Most of the "more experienced" PAs seemed to be less interested in the title whereas most of the younger newly graduated PAs were concerned for the title's effect on future job prospects and pay. 

      With that in mind, it seems that the most basic and vital thing to consider going forward is surely the TITLE of the profession. Like I said initially upon being selected for training, I just wanted to get through school and receive a title and degree. I wanted to be a PA because I was impressed with what they do and who they are; I still am. So for that reason, to me, it really wasn't a big deal what the official title was as long as I was able to become a provider. The issue I see now is that over time, the scope of a PA has become so much more than an "assistant." In 1998, PAs only had prescribing authority in 44 states which they now have in all 50 states, D.C. and Guam. There is a massive push for the profession to maintain a collaborative role as a member of a healthcare team in contrast to the push by NPs to have independent practice authority. I think practicing collaboratively is appropriate as that is precisely how we are trained, and for that reason, Physician Associate makes more sense generally speaking. It signifies that we aren't the king of the castle, nor do we intend to be, but we also hold authority commensurate of our training. I have been told on several occasions by my physician preceptor's throughout training to "take ownership" of my patients. I see it as a huge privilege to even be able to do so and appreciate the magnitude of caring for and managing a persons life. Don't be fooled that is precisely what you do or will do as a PA.

     There were approximately 234,000 licensed NPs in the US in 2017 according to the American Association of Nurse Practitioners (article here) and the main legislative and lobbying power of the NPs have pushed an agenda of requiring a doctoral degree as the baseline for training new graduates. The push for advanced degrees plays a significant political role and only inflames the NP vs PA debate. There are approximately 123,089 PAs in 2017 (reference here) which is substantially fewer than their NP counterpart. It seems that NPs have done a better job of coming together with a common goal and executing their plans in order to achieve their goals (whether or not you agree with their agenda or not).  In my own opinion, it is not necessary to obtain a doctoral degree in order to perform the role that both NPs and PAs fill, however, by requiring a doctoral degree as a standard for practicing NPs patients may feel that the training of a PA is lesser. By simply doing a quick google search, patient's will see that most NP programs are awarding Doctorates degrees and are able to practice without physician oversite or collaboration. A layman would easily come to the conclusion that an Assistant is lesser than an autonomously practicing Practitioner. I have already experienced this comparison first hand as I'm sure many of you have. I would also venture to say that you have been asked when you're going to go back to school and become a real doctor.

     There is already a disparity between healthcare providers and administrators with regard to what a PA is and whether or not NPs and PAs are equals. Having a unified front with regard to the title is the first step in this as "Assistant" may be misleading to all who hear it. The degree requirement, as well as the breadth of specialties and responsibilities, has changed over the years. It has moved from a Bachelor's degree and then to a Master's degree and I'm sure soon enough it will transition to a Doctorate's degree. This has never seemed to equate to necessity in practice but more a necessity of politics within the healthcare environment. Keeping up with the Jones' has become the status quo in healthcare. With that being said, PAs need to address the myriad issues plaguing the profession today, some of which have persisted for decades.

      There are many problems to address, here are a few: hiring, billing, and perception. Now, I am in the military and don't have to deal with this first hand at this point, but from what I have read, there are several instances where NPs have been hired over PAs simply because NPs require less paperwork as they don't require a supervising physician. This means there is less responsibility on the physician staff as well as a more streamlined hiring process for the healthcare administrators to consider. The other concern that is often mentioned along with the disparity between hiring NPs vs. PAs is the fact that monetary reimbursement becomes an issue when billed under the PAs NPI number rather than the Physicians. Medicare reimburses PAs at a rate of 85% of the Physician's fee for all services provided by the PA. There are some workarounds for this; however, it complicates the system and often leads to a convoluted billing requirement that places the care provided by the PA under ambiguous coding that falls under the Physician. This muddies the waters for services rendered by the PAs and makes it difficult to obtain accurate statistics about the care provided by PAs. Lastly, the perception of what a PA is to the administrators, physicians, and patients would be better reflected by the switch to Associate. 

     All in all, PAs will continue to set the standard for quality patient care and will continue to impact the lives of millions of patients regardless of their title. I know this is true. I am so fortunate to have a role in this profession. In due time, I will run for leadership positions within the governing organizations like AAPA and will do my part to advance our profession. PLEASE if you would like to express your opinion, I would LOVE to hear it in the comments down below this post. 

Associate has it 146 to 79...We'll ssee.

                          

                             Ryan Boudreau