Our mission is to empower PAs through advocacy and education; providing resources for physician assistants as well as the community in the pursuit of excellence for team-based medicine. 


FPAR / OTP  What does it all mean and where does it leave us?

The 2016 AAPA House of Delegates referred resolution A-08– PA Full Practice Responsibility–to the AAPA Board of Directors for further study. The AAPA BOD subsequently formed the Joint Task Force on the Future of PA Practice Authority.

The task force was charged to evaluate the need for changes in policy to, among other things, address perceived  disparities in hiring practices and reimbursement between PAs and APRNs in reponse to enactment of laws in 27 states allowing complete independent practice by APRNs . The belief was that because APRNs could practice independently employers were preferentially hiring APRNs over PAs since there was no supervisory responsibility tied to the APRN.

The AAPA Task force adopted the acronym of FPAR and embarked on collecting information to establish a position statement.  The process was flawed to say the least.  Information collected was incomplete, biased or completely non scientific.  They utilized surveys, public comment and blogs for some of their information and only engaged larger stake holders after pressure from AAPA members. 

Throughout the process, a movement continued to develop pushing for independent practice for PAs.  This “FPAR” movement insisted that the only way for PAs and the profession  to grow was to legally separate our ties with physicians thus enabling PAs to practice medicine independently.  Although this concept might appeal to some and might even seem appropriate in several remote, rural or underserved areas, there were several major flaws in the thought process.

1)    All 50 states, the District of Columbia and all U.S.Territories by law specifically restrict the independent practice of medicine to allopathic and osteopathic physicians.
2)    The argument that APRNs are allowed to practice independently therefore PAs should be allowed well is invalid because APRNs by law practice “advanced nursing” not medicine as do PAs.
3)    Our physician counterparts are our biggest allies when it comes to advocating for PAs and PA legislative progress.  To alienate them so readily without including them in the discussion completely disregards the bonds we have forged.
4)    New grads are not prepared to practice independently right out of school
5)    AAPA policy does not change anything at the state level.  The hard and expensive work to change legislation still needs to be done.
6)    There are no insurances that reimburse for independently practicing PAs.

Despite the above, the movement continued to grow.  The AAPA Task force, after talking to the stakeholders and with pushback from the AMA, rethought it’s overall stance and reworked their recommendations into a new policy recommendation (House Resolution 2017-A-07) loosely called “Optimal Team Practice” or OPT.  This would amend current AAPA policy HP-3500.3.4 “Guidelines for State Regulations of PAs” by striking all language requiring ties to physicians and adding a definition of OTP.

OPT, emphasized that PAs should maintain relationships with MDs/DOs but recommended striking the paragraphs that discussed collaboration. The amendments included with the resolution continued with clever wordsmithing which eluded a team based approach but also included phrases such as “State law should not require a specific relationship between a PA, physician or any other entity in order for a PA to practice to the full extent of their education, training and experience.”  Another part states that “The manner in which PAs and Physicians work together should be determined at the practice level”.

After 4 hours of debate and multiple offered amendments in a confusing vote at the end the HOD approved the Referendum and the amendment passed.

We are now stuck with an AAPA policy that does not serve us in a positive way for RI.  It creates concern and doubt that our mission is to practice medicine in a collaborative approach with our physician counterparts and we are already starting to see some local fallout from the national AAPA decision. 

The RIAPA is working to put together a formal position statement on the changes mentioned above. In the meantime please be sure of and continue to promote the following.

1)    The RIAPA stands committed to maintaining a team base / collaborative approach to the practice of medicine and does not seek legislation to sever ties with physicians for the purpose of independent practice.
2)    The RI General Laws as well as the Rules and Regulation of the RI Department of Health have not changed. DO NOT CHANGE THE WAY YOU PRACTICE BASED ON THIS POLICY AS IT DOES NOT APPLY TO ANY RULES OR REGULATIONS IN RI.
3)    Direct all questions and concerns to the RIAPA which may be contacted in the following ways.


450 Promenade Street, Suite A

Providence, RI 02908



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Discussion On Recent AAPA Policy

PAs Vote to Advance Profession to Meet Modern Healthcare Needs

2017 Marks 50th Anniversary of PA Profession

Contact: Carrie Munk, 571-319-4477, cmunk@aapa.org

LAS VEGAS (May 18, 2017) — At the annual conference of the American Academy of PAs (AAPA), members of its House of Delegates approved Optimal Team Practice, a new policy intended to enhance the ability of PAs to meet the needs of patients and ensure the future of the profession in a changing healthcare marketplace. This historic action comes during the 50th anniversary of the PA Profession, which was initially created to improve and expand healthcare.

PAs are state licensed medical providers who conduct physical exams, diagnose and treat illnesses, order and interpret tests, write prescriptions and perform medical procedures in nearly every practice setting and medical specialty.

“Passage of this new policy serves as a significant milestone for PAs,” said President and Chair of AAPA Josanne Pagel, MPAS, PA-C. “While Optimal Team Practice may take some time to fully implement in all fifty states and U.S. territories, it will most certainly enhance the profession’s ability to help patients, especially in rural and underserved areas, and reduce administrative burdens on physicians.”

Optimal Team Practice reemphasizes the PA profession’s commitment to team-based care, and in an amendment offered on the floor of the House of Delegates, reaffirms that the degree of collaboration between PAs and physicians should be determined at the practice level. It also supports the removal of state laws and regulations that require a PA to have and/or report a supervisory, collaborating or other specific relationship with a physician in order to practice. In addition, the new policy advocates for the establishment of autonomous state boards with a majority of PAs as voting members to license, regulate and discipline PAs, or for PAs to be full voting members of medical boards. Finally, the policy says that that PAs should be eligible to be reimbursed directly by public and private insurance for the care they provide.

With the addition of the amendment that reaffirms that the degree of collaboration between PAs and physicians should be determined at the practice level, the Physician Assistant Education Association (PAEA) offered its support.

Each state PA chapter can pursue the changes to state laws and regulations at its own pace and as the situation in each respective state allows. Optimal Team Practice resembles, but is not the same as, full practice authority, which nurse practitioners have been pursuing and have achieved in 22 states and Washington, D.C. The primary difference is the PA profession’s commitment to team based practice. PAs would continue to collaborate with physicians and other qualified medical professionals as dictated by the patient’s condition and the standard of care, and in accordance with each PA’s education, training and experience.

Pagel said the time was right to pursue these kinds of changes for PAs. “This new policy gives PAs the foundation on which to pursue legislative or regulatory changes that will enhance the profession’s ability to meet our nation’s healthcare needs.”

A list of frequently asked questions can be found on AAPA’s website here: http://bit.ly/2rw9gy4.

For more information, please contact Carrie Munk, AAPA vice president of communications, at cmunk@aapa.org, (571) 319-3047.



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