We have received many responses to the third part of our interview series with AMA President Steven J. Stack, MD, FACEP, “Strong Stance for Physicians: Dr. Stack talks doc shortages, APPs, and his teenage path to the presidency,” (September 2015).

AAPA Weighs In

As the President and Chair of the Board of the American Academy of Physician Assistants (AAPA), I have appreciated the relationship we have had with the American Medical Association (AMA). I am, however, deeply concerned about recent statements you made in ACEP Now regarding the role PAs play in today’s health care.

First, we completely agree with your statement that every provider should clearly identify themselves to patients. It is vital for patients to understand who is providing their care on the health care team. As an organization, we pursue truth in advertising and have clear guidelines to that effect.

On the other hand, in your statement, you group a number of different practitioners together including PAs, PharmDs, APNs, and NPs, disproportionately generalizing the role each of us plays and our goals. Specifically, you posit that “their professional societies’ push for enhanced autonomy flies in the face of everything in the modern era that supports team-based care.”

To be clear, we as PAs are individual health care practitioners striving to deliver the best patient care possible according to education, license, and experience. It is neither accurate nor productive to lump all providers and each of our objectives together.

As an organization, AAPA has made it our mission to uphold team-based care as a key pillar of the PA profession. PAs view medicine as a cooperative science, which is why teamwork and team-based care have long been at the core of a PA’s training.

In your comments, you acknowledge that PAs, physicians, and other health care providers can work well together. PAs collaborate within the health care team, and in that dynamic, they make autonomous medical decisions daily for their patients.

In the transformative shift from volume to value, away from a system that reimburses for each medical service to one that incentivizes and rewards better care and results, the team-based model optimizes value. PAs are uniquely equipped and ready to play an important role in this paradigm. PAs connect the dots in team-based care, work to make prevention as important as treatment, and help keep costs down.

For nearly 50 years, PAs have improved patient outcomes and elevated patient satisfaction, and there is clinical evidence, as well as real-world patient encounters, that demonstrate the high quality and breadth of PA care. In fact, the Association of American Medical Colleges recently published a paper discrediting concerns that quality of care will decrease with the deployment of PAs.

Author E.S. Salsberg, GW School of Nursing, summarizes: “…The increased adoption of team-based care which, if done correctly, allows for better use of skills of each member of the team…”

It is this type of coordinated, meaningful care that our system and patients benefit from, and we look forward to the next 50 years of continued collaboration with all of our health care practitioner colleagues.

We appreciate your consideration of our concerns and would be happy to discuss them and the AMA’s position in further detail.

Jeffrey A. Katz, PA-C, DFAAPA
President and Chair of the Board, AAPA

Dr. Stack Responds

Thank you for your letter regarding my ACEP Now interview.

I attempted to express a collaborative approach to team-based care in which all clinicians perform roles consistent with their education and training and patients are fully informed of the qualifications of their care team members. I am grateful that a substantial portion of this message was received positively.

In this context, I certainly meant no offense to physician assistants and appreciate the commitment of physician assistants to the team approach to care. We value our partnership with physician assistants and your individual contributions as members of health care teams.

As you observe, health care in the United States is in the midst of profound change. We look forward to working with our physician assistant colleagues to make the most of these changes to ensure that patients throughout our nation have access to high-quality and affordable care.

Steven J. Stack, MD
President, AMA