The speed of change in recent years for the PA profession has taken my breath away. I have simply been astounded at how quickly positive change has come in numerous areas that affect PAs' ability to serve their patients and communities. The barriers to effective and efficient physician - PA practice continue to fall at every level.
While change can be glacial in the health care system at times, if you observe as long as I have, significant movement is evident (smile!). I have also learned that determined individuals can make a local difference, armed with the right tools.
A prime example is the local environment in my home town, Bakersfield. I work for an Adventist Health hospital, with a strong sense of mission and vision, which focuses on community service. I joined the medical staff two years ago and have had the good fortune to work with medical staff people who understand that barriers to good physician - PA practice interfere with the mission of the hospital.
One example is due process on the medical staff. When I arrived at the hospital, “non-physician” clinicians (NPs, PAs, CRNAs) could find their privileges revoked with the stroke of a pen by the chief of staff. No hearing, no evidence – just out the door at the whim of one person. Our only association with medical staff was credentialing; there were no other privileges, such as committee membership. Along with the hospital experts at the AAPA, using the model hospital privileges and JCAHO standards, we have been able to work with the physician and non-physician leadership of the hospital medical staff to make a dramatic change in the hospital bylaws, which culminated in December.
This change includes full medical staff membership for PAs and others, due process, committee voting membership, and the ability to take our place alongside our physician colleagues in monitoring and improving the care delivered in our facility. PAs support physician-led teams at every level and have a lot of experience and expertise to add in supporting the governance work of medical staff.
So, I now find myself on the Credentialing, Surgery, and Clinical Improvement committees. Rules on co-signature, rounding, procedures, etc, have been dramatically improved to allow them to be more practice based and at the discretion of the supervising physician, while still maintaining patient safety and quality as our highest standards. This all positively affects the work environment for PAs and others at our facility.
The better news is that this change will create a ripple effect in the community. (It already is in the Adventist Health system.) The state-of-the-art PA working environment is already attracting the best and brightest PAs in the community and will encourage other hospitals in our community to remove their barriers to physician-PA practice. Failure to do so will make it difficult for these facilities to recruit and retain increasingly scarce PAs and other health care providers.
Ann Davis of AAPA staff fame is fond of saying “If you are not at the table, you are on the menu.” Never doubt that as a committed individual, you can make a positive local change.
Steve Hanson is immediate past president of the AAPA.