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WAPA Testimony on Proposed Recommendations to the Medical Examining Board concerning MED 8

Wednesday, July 26, 2017   (0 Comments)
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Discussion of Physician-Physician Assistant Relationship


To: Members, Council on Physician Assistants Tom Ryan, Executive Director

From: Julie Doyle, MPAS, PA-C, Member-at-Large WAPA Advocacy Committee

Date: April 28, 2017

Subject: Proposed recommendations to the Medical Examining Board concerning MED 8

Discussion of Physician-Physician Assistant Relationship


The Wisconsin Academy of Physician Assistants represents a significant number of physician assistants who provide health care, both primary care and specialty care, to citizens across Wisconsin. On behalf of the Wisconsin Academy of Physician Assistants (WAPA), I respectfully request these comments be formally included in the record of today’s Council on Physician Assistants meeting. I submit these comments regarding the following two items on your agenda: the proposed recommendations to the Medical Examining Board concerning MED 8 and the discussion of the physician-physician assistant relationship.


Proposed Recommendations to the Medical Examining Board Concerning MED 8


WAPA generally supports the proposed MED 8 changes suggested by council member Jennifer Jarrett. These changes would, I believe, be an important step in improving the physician-physician assistant relationship in Wisconsin and would result in a great improvement to the state of physician assistant practice and patient care in Wisconsin. WAPA is still in the process of reviewing MED 8 in light of the changes suggested by Ms. Jarrett and will provide you with additional feedback when it is available.


Many of the changes recommended by Ms. Jarrett better reflect the physician-physician assistant relationship in many practice settings and the level of physician assistant education and training. For example, we approve of deleting “or hands on assistance of the supervising physician” from 8.01(2) as it is needless because physician assistants may practice without the physical presence of a physician, as noted by Ms. Jarrett. In addition, adding “ordering” to  8.07 (2)(b) recognizes that physician assistants are able, thanks to their training and certifications, to place orders. Finally, Ms. Jarrett’s suggested change to 8.10 (1), that is, deleting the existing 4:1 physician assistant:physician ratio would allow better access to care in rural Wisconsin, inner cities, and in urgent care clinics. WAPA appreciates the significance of these changes, particularly the  physician assistant:physician ratio change, and would welcome the opportunity to discuss these changes and potentially other changes to MED 8 with our physician colleagues.  


Discussion of the Physician-Physician Assistant Relationship


Perhaps even more important than updating MED 8, WAPA is interested in reviewing the current statutes governing the fundamental physician-physician assistant relationship. In fact, WAPA has already begun initial, informal discussions with other potentially-interested stakeholders, such as the Wisconsin Hospital Association and the Wisconsin Medical Society, to name a few. I would like to stress these are initial discussions to solicit preliminary, informal feedback. WAPA anticipates many more discussions need to be had with representatives of these associations and many others as we consider statutory revisions affecting this relationship.


The main thrust of these discussions is to define in a new way the physician-physician assistant relationship. While the physician-physician assistant relationship is currently articulated in statute as a supervisory relationship, WAPA seeks to articulate the relationship emphasizing physician assistants as part of team-based care. To be clear, WAPA is not suggesting nor are we advocating for independent practice by physician assistants. Physician assistants value the relationships we have with physicians, nurses, and the other healthcare professionals with whom we practice. WAPA is suggesting the practice of healthcare has greatly evolved and changed since the basic structure of the physician-physician assistant relationship was established in Wisconsin statutes. We would like to work with other stakeholders to update Wisconsin statutes to better reflect the level of healthcare physician assistants are educated and trained to deliver, particularly in underserved areas of the state, such as rural Wisconsin and inner cities.


Again, WAPA has begun initial, informal discussions. WAPA intends to continue these discussions in order to gauge the interest and willingness of Wisconsin hospitals and physicians, among others, to update the statutes governing the physician-physician assistant relationship.


Thank you very much for considering these comments. On behalf of the Wisconsin Academy of Physician Assistants, we look forward to working with you on these issues.