Physician Assistants Try to Gain Leverage with Legislators
Proposed legislation would change the licensing process, placing more responsibility in the hands of the supervising physician
January 13, 2011 -- The Oregon Society of Physician Assistants has prepared legislation to change the licensure process by placing more responsibility in the hands of the PA’s supervising physician and less on the judgment of the Oregon Medical Board.
While the OSPA and physicians claim it’s essential for PAs to work at their full capacity, the Board fears for patient safety if its power to judge a PA’s qualifications is diminished.
A legislative draft (Senate Bill 224), printed on Monday, is “very much a work in progress,” said Tom Holt, OSPA’s lobbyist, but already has bipartisan support in the House and Senate.
Testifying before the Senate’s Interim Committee on Health Care last month, Ted Ruback, head of the PA training program at Oregon Health & Science University, said the legislation’s primary goal was “to allow the supervising physician to determine the practice description and competency of the PA.” Currently, the Board is responsible for this, which OSPA lobbyist Scott Beyer sees as problematic.
“The difficulty with the Board is that they have turnover in their membership,” said Beyer. “Some PAs have been doing procedures for years, but a new Board member comes on and says, ‘I didn’t know they could do that, that concerns me,’ and they end up prohibiting PAs from doing certain procedures.”
Longtime PA Edwin Weih has felt the impact of the Board’s decisions firsthand. As the sole medical provider in the rural community of Oakridge, an hour southeast of Eugene, he attends to a wide range of medical needs for the town’s 3,500 residents. But over the years, the Board has ruled that PAs cannot perform certain procedures that Weih once did routinely. He used one such procedure, an endometrial biopsy, to diagnose cancer in an elderly patient and refer her to the nearest surgeon, an action that helped save her life.
“A few years after that, the Board said that PAs must submit a practice description listing anything they did outside the ‘core competencies,’” said Weih.
“I listed everything I did, and all the procedures were denied me,” including endometrial biopsies. He claimed, and other sources confirmed, that his predicament was shared by numerous PAs in Oregon.
The Board’s limitation of PAs’ duties to certain ‘core competencies’ in 2002 was part of a multi-state effort to more explicitly define a PA’s scope of practice. However, Ruback said, “It was proven to be ineffective, and the vast majority of states … have moved to a physician-delegated scope of practice for PAs.” Why? According to Ruback, “The person best suited to determine a PA’s qualifications and competencies is the doctor who works with them on a daily basis.”
Ruback served on the Board’s PA committee for a decade before resigning last year to become more involved in advocating for PA licensure legislation. He characterized the Board’s decision-making process regarding PA qualifications during his tenure as “nothing more than guesswork. We were trying to make decisions about PAs in a global way when we had no context for their daily practice.”
Not surprisingly, the Board sees things differently. “The Board plays a critical role in terms of patient safety, including [PA] practice descriptions,” said Kathleen Haley, the Board’s executive director, who noted that, “We’re working with the OSPA and the Oregon Medical Association to problem-solve, keeping patient safety foremost while balancing that with patient access.”
Access to healthcare is a longstanding issue in Oregon that will only intensify as provisions of federal healthcare reform are enacted. By 2014, health insurance will be extended to hundreds of thousands of previously uncovered Oregonians. Some observers contend that curtailing the responsibilities of PAs over unwarranted safety fears will impede access to care when and where it’s most needed.
“In all of the healthcare legislation, you see the [words], ‘using people to the fullest extent of their education,’” said Ruback. “We can’t afford to restrict responsibilities and access.”
At a Senate hearing in December, Sen. Jeff Kruse (R-Roseburg) described the legislation as a “no-brainer,” while Sen. Alan Bates (D-Ashland) assured those testifying that the Committee was “very supportive of your request [for legislation].” Now it’s up to the stakeholders to find common ground.
FOR MORE INFORMATION:
Full text of Senate Bill 224 (draft): http://www.leg.state.or.us/11reg/measures/sb0200.dir/sb0224.intro.html
Current Oregon Medical Board licensure process for Physician Assistants:
State-by-state laws for Physician Assistants:
Jan 12 2011