PAVMT Response to AMA #StopScopeCreep Campaign

Medicine is not a “game.” By promoting divisive campaigns, the AMA jeopardizes the patient care team and thus affects patient safety.  

On October 31, 2020, the American Medical Association (AMA) posted, (then deleted and reposted with different language) an item on their official Facebook account about a campaign called "#StopScopeCreep." The post suggested the AMA's position: the AMA believes PAs, NPs, and CRNAs are expanding their scope of practice too significantly and that these professions don’t take patient safety seriously. The AMA implies PAs threaten patient safety as a byproduct of scope expansion legislation but offers no references or additional studies to support this statement. A search of the AMA website using terms “#StopScopeCreep” and “Stop Scope Creep” yields only two editorial articles highlighting results from a patient preferences and perceptions survey about physician-led care^1,2. Additionally, the AMA offers no direct access to the survey questions or underlying data for objective analysis from which they draw these limited conclusions.

That the AMA throws PAs, NPs, and CRNAs in the same regulatory bucket is frustrating and continues misconceptions about efforts to change practice legislation across these professions. From this view, the AMA interprets any efforts to advance the scope of practice as inherently wrong, regardless of the underlying rationale or evidence to support the change. It also demonstrates an ignorance of the difference between PA legislative goals from those of NPs or CRNAs. 

Optimal Team Practice (OTP) is a national PA policy effort developed by the AAPA to optimize PA scope and training. OTP will ensure every PA has a practice-level agreement that is individualized and relevant to their practice and the care team. The agreement establishes with whom the PA may collaborate, including physicians, other PAs, NPs, and other licensed clinical professionals. 

PAs currently practicing or aspiring to practice in telemedicine specifically experience the challenge of current PA legislative requirements. PAs are well-trained to treat patients via telemedicine as the visits are the same acuity the PA would see in a traditional office visit. However, PAs across the country report difficulty securing these roles. In the direct-to-consumer (DTC) telemedicine space in particular, many employers refuse to hire PAs due to the complexity of our regulatory requirements or the need to have a supervising physician. 

PAs in Virtual Medicine and Telemedicine (PAVMT) is the voice of PAs in telemedicine. Our advocacy efforts are ongoing and continuous outreach to telemedicine employers, particularly those that do not hire PAs. In our conversations with telemedicine employers, none have referenced the complexity of care or PA competency as a rationale in their decisions. With few exceptions, every employer has referenced PA supervisory requirements as the primary reason for not hiring PAs. To quote the Chief Medical Officer - a physician - of one of the largest direct-to-consumer telemedicine groups in the US, “we would hire PAs if it weren’t for their supervisory laws.” Our conversations with these organizations clarify that modernizing legislation is necessary to ensure patients have reliable access to care and that PAs have equity in seeking jobs for which they are eminently qualified.

Our current legislative map clarifies the reality that we must evolve to support more optimal utilization of our finite clinical resources. We have an ongoing physician shortage that is only worsening. Time and again, PAs have been shown to be safe, effective, and highly qualified healthcare providers. The HHS stated the same in their 2018 report indicating that current Federal and state-level regulations unnecessarily restrict our ability to practice effectively.³ That the AMA would choose to take this position now is ignorant of the world around us. While our healthcare system - and our nation - are suffering, the AMA has decided to double down on a turf war between clinical professionals that is not supportive of improving patient outcomes.

The challenges facing our healthcare system are significant; a modern healthcare system requires modern solutions. We cannot merely obligate clinicians to “remain in their lane” because it’s familiar or convenient. We must find creative solutions to maximize all clinicians’ impact regardless of the letters after their name. Healthcare is a team-based endeavor, and that team will look significantly different from one clinical setting to another. While the AMA sees legislative change efforts as "scope creep," PAVMT supports these efforts as necessary to ensuring better access and safety for our patients. 

Amanda Shelley, MPAS, PA-C

President and Co-Founder, PAs in Virtual Medicine and Telemedicine

References

1. Robeznieks A. Why patients want doctors to lead the care team. American Medical Association. Payment and Delivery Models Web site. Published 2020. Accessed November 1, 2020. https://www.ama-assn.org/practice-management/payment-delivery-models/why-patients-want-doctors-lead-care-team. 
2. Robeznieks A. Scope of Practice: How the AMA fights for patient safety. American Medical Association. Payment & Delivery Models Web site. Published 2020. Accessed November 1, 2020. https://www.ama-assn.org/practice-management/payment-delivery-models/scope-practice-how-ama-fights-patient-safety. 
3. Reforming Americas Healthcare System Through Choice and Competition. In: UDoHHS, UDotT, UDofL, ed. Washington, DC: US Department of Health and Human Services; 2018:120. p.41. Accessed November 1, 2020. https://www.hhs.gov/sites/default/files/Reforming-Americas-Healthcare-System-Through-Choice-and-Competition.pdf