Physician associates again ask AMA to end ‘disparaging rhetoric targeted at the PA profession’

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Physician associates said the American Medical Association (AMA) has not responded to their request to collaborate and blaze “a better path forward” for the U.S. health care system.

The American Academy of Physician Associates (AAPA) sent a July 30 letter to AMA President Bruce A. Scott requesting a meeting by the end of August “to discuss the impact of AMA’s disparaging rhetoric targeted at the physician associate (PA) profession.”

“Regrettably, this date has now passed without a response from the AMA,” said a Sept. 3 follow-up letter from AAPA President and Board of Directors Chair Jason Prevelige, DMSc, MBA, PA-C, DFAAPA, and Academy CEO Lisa M. Gables, CPA. The issue is timely as 2024 winds down and lawmakers prepare for a new legislative year 2025.

“While our two organizations may not see eye to eye on every policy, we trust that there are areas of common ground,” the AAPA letter said. “However, the continued silence from the AMA raises concerns about your commitment to collaboration and finding solutions to strengthen America’s health care workforce and improve patient care. We urge the AMA to reconsider its stance and join us in addressing the pressing needs of today’s health care environment, rather than maintaining outdated practices that no longer serve the best interests of patients.”

‘Scope creep’ – helping or hurting health care?

AAPA has taken aim at AMA’s continuing “scope creep” campaign. AMA argues: “Patients deserve care led by physicians – the most highly educated, trained and skill health care professionals,” said the web page dedicated to the issue. Expanding practice privileges and abilities to nonphysicians could threaten patient safety, according to AMA.

But AMA misrepresents contributions of PAs and does not reflect the views of many physicians, said the letter from the AAPA leaders. The Academy amassed more than 8,000 physician associate signatures on an accompanying letter expressing their concerns.

“The most effective health care for people occurs when clinicians work together as a team, and many of our physician colleagues recognize and value the critical role PAs play in patient care and believe in the power of team-based care over preserving outdated hierarchies,” the accompanying letter said.

PAs speak out

The AAPA letter included findings from a survey of more than 4,900 physician associates. When asked about the AMA’s scope creep efforts, 96% said it had a negative effect on addressing health care workforce shortages and more than 95% said it hurts efforts to expand health care access.

The AMA’s campaign is negatively affecting patients’ understanding of PA qualifications to provide care, according to 89.5% of the PA survey respondents. Almost 92% said it has negative effects on patient trust in the U.S. health care system, while 81.7% reported a negative or very negative effect on PA relationships with patients.

“Patients deserve to have full confidence in the qualifications and expertise of all health care providers,” Prevelige and Gables’ letter said. “Given that PAs treat and connect with patients often during some of their most vulnerable moments, it is our responsibility to foster trust in PAs to ensure their needs are being met with quality care.”

AMA: Doctors must lead care

At recently as June, the AMA House of Delegates adopted policies relating to scope of practice for PAs, nurse practitioners (NPs), and dentists.

AMA cited federal data showing 24% of NPs work in primary care. But there is little data about how often NPs change specialties, and NPs and PAs tout ease of changing specialty as a career benefit for both professions. State licensing laws require NPs and PAs to graduate from accredited programs and get certified by a governing body. NP and PA certifications “are extremely broad,” and NPs and PAs may end up working with patients or conditions they don’t have formal education or training in, according to AMA.

The Association encouraged hospitals and health systems to ensure NP and PA certifications align with practice specialties and will continue educating regulators about training and specialty switching.

AMA is reviewing current research on political misinformation and disinformation presented about scope of practice, along with the best ways to correct it. State or federal lawmakers also should prohibit emergency department staffing ratios that do not allow for proper physician supervision of nonphysician providers.

AMA also opposes dentists and dental hygienists injecting patients with dermal fillers and neurotoxins, including onabotulinumtoxinA, marketed as Botox. Those treatments require health professionals with experience in dermatology or plastic surgery, but allowing dentists and dental hygienists to administer them jeopardizes patient safety, according to AMA.