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Last Updated: Oct 14, 2021

Recently we reported on legislation that will, among other things, streamline the process through which physicians must navigate on behalf of their physician assistants (PAs).

You may wonder why PAMED supports this legislation?

PAMED supports legislation that helps our members. A few key benefits to our physician members include;

  • The legislation will significantly decrease the “start-up” time required to employ a PA by no longer requiring Medical or Osteopathic Board approval of PA agreements
  • The legislation will require the Boards to review 10% of filed agreements each year.
  • The legislation will allow physicians to determine the degree of oversight they wish to employ over their PAs as it relates to medical chart reviews
  • The legislation continues to require 100% chart reviews for 12 months for new PAs entering the workforce and for those who may be changing medical specialties

These measures no longer require “on-site” supervision of PAs paving the way for physicians to employ telemedicine and other modern communication measures to ensure appropriate oversight. They also increase the allowable supervisory ratio from 1:4 to 1:6. Please note that efforts to remove ratios entirely was rejected by the physician coalition.

What the bill DOES NOT do;

  • Expand a PA’s scope of practice
  • Diminish a physician’s responsibility to appropriately supervise PAs to ensure the care they are providing to patients is appropriate.

At PAMED’s insistence, and with the support of the physician coalition, language was included that protects physicians who may be asked or forced to supervise more PAs than they feel is clinically appropriate. “This provision of the bill is critical to physicians employed by hospitals who may not feel comfortable supervising a PA they don’t know or being asked to supervise too many PAs at one time," Dr. Michael DellaVecchia, PAMED President notes. “It’s always about patient safety and the delivery of quality health care.”

The bills, SB 397-398, are the product of several years of intense negotiations between a coalition of physician organizations and the PAs, and have been signed into law (now Act 78 and Act 79). The physician organizations included The Pennsylvania Medical Society (PAMED), the Pennsylvania Academy of Family Physicians, the Pennsylvania Chapter of the American Academy of Pediatrics, the Pennsylvania Chapter of the American College of Physicians, and the Pennsylvania Orthopedic Society. The Hospital and Health System Association of Pennsylvania was also a participant in the process of developing the proposals.

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  1. Danae Powers | Oct 18, 2021

    OK - I just feel compelled to respond:

     

    This will definitely expand the scope of practice; as has been desired for some time by the staff leadership of PAMed and s significant number of the Exec

    Committee and some more on the BOT.  Would recommend that PAMED be honest about the facts and state why they think this is a good idea, instead of acting like the

    truth is not the truth.

     

    To point out the obvious on just a FEW points, when I was on the Exec Committee, it was made very plain that requiring approval by the Board of Medicine kept contracts from being written that expanded the scope of practice;also that employed doctors were not able to object to terms of supervision or lack of chart review being pushed by their employers because it could threaten the employed doctors job security. This was easily understood ....and point by point discussion of the specifics revealed that.....For example, we had input from members of the Board of Medicine stating that they had seen very inappropriate contracts that would have allowed PAs to practice way beyond what was safe based on the PA training, and that the Board of medicine DID timely reviews- delays were almost always due to errors in the submission from the institutions or docs ( that may have gotten worse or better since ?)

     

    However, there were and are the folks in leadership, both staff and docs, who felt that PA's should have more autonomy and that systems such as the large hospitals should be allowed to replace physician care by midlevel care. They felt that there were good reasons to do so, often agreeing with the perspective of the Pa Hospital Association.  I was present at many many of the discussions and heard their frustration with the HOD and membership for opposing the increase in autonomy....

     

    Let's just be open and clear about the issues and have an open and clear presentation.  Do we believe that honesty is the best policy in the long run??

     

    Needless to say, I have heard from members already about their anger with PAMED for letting this happen without even a notice to membership first. NO one has called to say they are happy with PaMEd - but maybe other past presidents from PAMED are getting those communications??   

     

     

     

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