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PA Law Modernization in Wisconsin
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What are the problems PAs are trying to solve?

An August 2016 report from the Wisconsin Council on Medical Education and Workforce (WCMEW) warns that Wisconsin may face a shortage of more than 2,000 physicians by 2030.   PAs like other healthcare professionals are concerned with this and other healthcare provider shortages - especially in rural areas of the state.   Both PAs and Advanced Practice Nurse Prescribers (NPs) can help address these shortages, but the Wisconsin laws governing PAs have not kept up with how healthcare is delivered today. The physician-PA relationship under the law is “supervisory,” while the physician-NP relationship is collaborative.

 

 

How are PAs looking to solve the provider shortage problem?

PAs believe that laws governing PAs should be evidenced-based, allow PAs to practice up to the appropriate limits of their training and educations, and don’t undermine the ability of PAs to provide the services they are qualified to provide, particularly in rural Wisconsin.

Enacting best practices and updating Wisconsin law has the potential to:

  • Increase patient access to care;
  • Decrease costs and burdens on Wisconsin’s healthcare system; and
  • Eliminate barriers for PAs to provide service in rural and other underserved areas.

Many current PA laws were created in the 1960s and 1970s when the PA profession was created to address healthcare shortages - especially in rural areas. Many studies demonstrate that PAs provide high-quality care and that PAs are a safe provider. PAs have an extremely low medical malpractice rate and discipline rate.

 

 

What are some of the practice barriers PAs are considering and why?

The changes that Wisconsin PAs are considering have already been enacted in other states or have been adopted by the Veterans Administration and the Uniformed Services. Last session, Minnesota, Michigan, Illinois, and Indiana enacted modernization provisions.

Below are examples of barriers Wisconsin PAs are considering pursuing: 

 

Barrier

Problem

Consideration

Physician limited to working with not more than four PAs

Limits the number of PAs in Wisconsin, especially in rural areas where there is already a physician shortage

Any ratio limit should be set at the practice setting.

PA-physician relationship described as “supervisory” in statutes.

Causes confusion among insurers, payors, and legal departments, that result in PAs not being able to provide patient care PAs are qualified to provide.

Allow PAs, physicians, and the practice setting to determine the relationship.

A physician must accept responsibility for any action by a PA.

Increasingly, physicians are less likely to accept this responsibility since both PAs and physicians are typically both employees of a healthcare organization.

Each professional accepts responsibility for their own actions.

A PA’s scope is limited to the qualifications of the physician the PA works with.

A fully-credentialed PA is prohibited from providing patient care unless the physician is also qualified.

Allow what services PAs provide to be determined at the practice setting, such as the credentialing process at a hospital or clinic.

PAs do not regulate their own profession. PAs are regulated by another profession.

PA regulations have not kept pace with healthcare changes, because PAs have not regulated their own profession like other professions. One profession regulating another also exposes the state to significant legal liability under a recent US Supreme Court ruling.

Create an independent, self-governing PA board, such as that enjoyed by nurses, dentists, chiropractors, and physicians.

 

 

 

What are PAs not considering?

PAs practice on a healthcare team and value their relationship with physicians. Wisconsin PAs are not seeking independent practice.

Wisconsin PAs are not pursuing mandates on providers, plans or healthcare organizations (like hospitals).   In fact PAs believe that decision-making should be made at the practice setting.

 

 

Where are PAs in the process?

WAPA (Wisconsin Academy of PAs) began by surveying PAs asking what challenges they face and what changes they support pursuing.

Since then , WAPA  has been reaching out to stakeholders such as groups that represent providers and healthcare systems as well as public policymakers for feedback and advice on solutions to meet the healthcare shortage - especially in the rural areas of the state.

Based on that feedback, WAPA will continue  working with members of the Wisconsin legislature to draft legislation and engage in formal discussions with stakeholders to reach a consensus.

 

 

What can PAs do?

This is one of the largest modernization efforts of a state PA law. Building an effective coalition will be critical. PAs should:

  • Introduce themselves to their legislators and invite them to tour their practice setting.
  • Ask their physician colleagues for feedback and advice on the barriers and solutions PAs are considering - encourage them to contact their professional organizations to express their concerns.
  • Encourage their employer to support eliminating practice barriers by contacting their professional organization and encouraging active support.