Announcement of Public Workshop, "Examining Health Care Competition" ("Health Care Workshop") Project No. P13-1207 #00056

Submission Number:
Paula Havisto
Initiative Name:
Announcement of Public Workshop, "Examining Health Care Competition" ("Health Care Workshop") Project No. P13-1207
I am a licensed practicing PA in primary care and work in a rural area of the Upper Peninsula, Michigan on an Indian reservation. The PA scope of practice is similar to that of a physician and I am held to the same standard of care as a physician. I have a masters degree in medicine. My profession has experienced unnecessary burdens which include tethering our license and livelihood to that of a physician. I was compelled to leave a job when my supervising physician was no longer able to provide services at a rural clinic I was employed at. This is one of the onerous restrictions that PAs face today. PAs, in order to practice at the top of our licenses must have the restrictions of dependence and supervision removed from regulatory language. Most PAs obtain Masters degrees and some obtain a Doctorate degree in a health care field. We are educated in a medical model and many PA schools are housed in University Medical Schools. Our training is in medicine and we sometimes sit side by side with medical students in our first year of school. We are not medical assistants and are often confused with them. At one point in our history our title was Physician Associate but we were forced to change the name back to assistant when the AMA decided they did not approve of our title. Many PAs advocate for a return to the Associate title or other nomenclature since the assistant title causes much confusion with patients, the public, and insurance companies. I have reviewed the Policy Perspective entitled: Competition and the Regulation of Advanced Practice Nurses, FTC - March 2014. In every sentence of that paper the word Physician Assistant can be substituted for Advanced Practice Nurse. PAs face the same challenges as Nurse Practitioners and have the same safety profile and competency studies as NPs. The PA profession was developed nearly 50 years ago and we have since proved our worth and value to primary care medical practices. Our profession in controlled by another (physicians) and this has caused great restrictions in our scope of practice. After 10 years of medical experience as a PA I practice at the same level as my collaborating physician. The FTC needs to look closer at the barriers that PAs face. These barriers include denial by insurance companies for adequate or equal reimbursement for the same services provided by physicians, denial by CMS to order home health care and other services, denial by CMS to be full eligible professionals for HITECH reimbursement, and the reports that PAs are losing jobs when an NP can be hired instead when the NP works in a state that grants them full practice authority. In addition there are 50 different state laws and licensing requirements that set up barriers and changes to what a PA can and cannot do when they move to a different state. This includes prescribing authority as well. The PA and NP professions were born at the same time. The NP profession was an offshoot of the PA profession. Both disciplines provide high quality care to the citizens of the US and both professions deserve to have equal standing and consideration by the FTC. With the complicated changes going on in medical care and with the shortage of physicians in primary care, PAs are equipped to rise to the challenge to become the primary care providers along with NPs. PAs initially were trained to be like the General Practitioner MD and we filled the needs of the rural and inner-city areas that physicians would not go to. I am calling for the FTC to support the PA profession in the same manner as it supports the NP profession.