Statement: PAMED Expresses ‘Serious Concerns’ with Elements of President Trump’s Executive Order

Last Updated: Oct 11, 2019

The following is a statement from Danae Powers, MD, president of the Pennsylvania Medical Society:
On behalf of the physician members of the Pennsylvania Medical Society (PAMED), I applaud President Trump’s recognition of the non-clinical administrative hurdles that physicians face as outlined in his recent executive order on “Protecting and Improving Medicare for our Nation’s Seniors.” Bureaucratic red tape coupled with the intrusive reach of health insurers is disrupting the physician-patient relationship and having a negative impact on care.
While we agree that enabling physicians to spend more time with patients would improve clinical outcomes, PAMED has serious concerns with Section 5 (c) of the president’s order that we believe is antithetical to providing our seniors with the highest quality care possible.
It suggests an expansion of the scope of practice for nurse practitioners and physician assistants by eliminating supervision requirements that, according to the executive order, “limit professionals from practicing at the top of their profession.” In addition, it says services for nurse practitioners and physician assistants should be “appropriately reimbursed in accordance with work performance rather than the clinician’s occupation.”
PAMED, and physicians in general, have long embraced the concept of delivering care through teams of providers with each offering a skill that complements the others. We appreciate the valuable input non-physician providers contribute to the team; however, it is important to note that the clinical skills of each team member are not interchangeable.
Today, thousands of young high school students are dreaming of becoming physicians. Some may want to become pediatric neurosurgeons because of a friend who succumbed to a glioblastoma, while others are interested in family medicine after witnessing the healing touch of a physician’s hand on the shoulder of an ill grandparent.
We have great concern that espousing a policy that fails to recognize the duration and intensity of medical education, as compared to training of non-physicians, and the significant differences in their clinical acumen, will send the wrong message to these students and may dissuade them from one day becoming physicians.
As we age, the complexity of illness requires a health care professional who possesses the clinical acumen to appropriately and effectively treat patients who often have conditions involving several comorbidities. The level of reimbursement between providers that the president references in 5 (c) are not in fact disparate, but rather reflective of different clinical skill levels each provider employs on behalf of patients.
We believe the ramifications of implementing payment parity between physicians and non-physicians, as recommended in the president’s executive order, will ultimately jeopardize the level of care seniors receive.  
Although this executive order acknowledges the applicability of state laws that govern scope of practice limitations among non-physician providers, we find the inference of equivalency between health care providers is alarming. We encourage the president to rethink that recommendation.
As physicians, our number one priority is the health and welfare of our patients, especially the elderly whose care is often complex and difficult. Fracturing health care delivery teams, as the president recommends, will create silos of uncoordinated care and will not be in the best interest of patients.
As Health and Human Services Secretary Alex Azar reviews the components of the president’s executive order for the purpose of implementation, it is our sincere hope that physician-led, team-based care will remain intact.
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Media Contact
Jeff Wirick
Pennsylvania Medical Society
About the Pennsylvania Medical Society
The Pennsylvania Medical Society helps its 22,000 physician and medical student members return to the art of medicine through advocacy and education. Learn more by visiting or by following us on Twitter at @PAMEDSociety.

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  1. Craig Johnston | Mar 31, 2020
    I read the above Update with great interest.  My son is a medical student and brought it to my attention. Could you let me know if anything further has occurred in regard to this.   Thanks.  Craig T. Johnston, D.O.

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