This week, New York Gov. Andrew Cuomo (D) issued a crucial executive order that gives physician assistants (PAs) in the state the flexibility they need to contribute as much as possible to the COVID-19 response.
In many states, PAs are required to have a supervisory or collaborative agreement with a physician in order to practice. During disasters and emergencies, these agreements complicate where and how PAs are allowed to practice, sometimes preventing them from stepping in where they’re needed most.
Just three states — Tennessee, Maine and now New York — have waived physician supervision requirements through executive orders related to COVID-19. While 14 states have previously removed physician supervision requirements for PAs during emergencies or disasters, that still leaves the majority of states without this crucial provision.
In order to mobilize the full PA workforce, more states need to waive these supervision or collaboration requirements — and they need to do it immediately.
The American Academy of PAs is calling on all governors to include language in executive orders waiving physician supervision or collaboration requirements during a declared public health emergency or disaster. There is no time to lose.
PAs are highly qualified medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications and often serve as a patient’s principal healthcare provider.
PAs who work in hospitals, urgent care and primary care settings are already a significant part of the on-the-ground efforts to diagnose and treat the coronavirus. Many more PAs have answered the call to assist in any way they can.
We are an army of qualified, well-trained medical providers ready to deliver care — but we need more flexibility to step up and serve beyond our normal scope, if we are called to do so.
One problem with supervisory or collaborative agreements is that they severely limit a PA’s flexibility to provide care in fluid situations like the current COVID-19 crisis. Thanks to their generalist medical education, all PAs are capable and qualified to test and diagnose potential COVID-19 patients.
As an example, a surgical PA who is no longer in the operating room because elective procedures have been postponed could help test and diagnose patients at their hospital. But because the physician with whom that PA has an agreement would not be working with them to test and diagnose patients, the PA can’t either. In a healthcare crisis like this one, these limitations simply don’t make sense.
The best way to remove barriers to PA practice is at the state level through legislation. Many state legislatures have recently ended or adjourned due to COVID-19, so now it’s up to state governors to recognize the need to give PAs greater flexibility and act as soon as possible to grant it.
A pre-COVID 19 report compiled by the U.S. Departments of Health and Human Services, Treasury and Labor recommends that states remove requirements for rigid collaborative practice and supervision agreements between physicians and PAs. Now more than ever, this change will allow PAs to practice at the top of their education and training and utilize their full skillset when patients need them most.
An effectively mobilized and comprehensive COVID-19 response requires all hands on deck. In the coming weeks, many providers in a variety of settings and specialties will be called to serve in ways they have never been called on before.
All healthcare professionals are ready. This, after all, is what we signed up to do — care for people. Save their lives. Nothing should stand in our way.
Every practicing PA I know is willing and eager to do what is needed in the response to COVID-19. While many are already involved administering tests, diagnosing and treating patients, others are held back by restrictive laws. These are unprecedented times — getting through them will require every health care provider’s full attention and ability.
Do not wait any longer. Governors must empower the PA workforces in their states to ensure they have the flexibility that they need to meet patients’ needs. I can promise you: PAs are ready to answer the call.
David E. Mittman, PA, DFAAPA, is the president and chair of the American Academy of PAs (AAPA) Board of Directors. As a long-time member of the Academy, he has served in numerous PA leadership roles over the last 30 years, including serving on the AAPA Board of Directors, the AAPA House of Delegates, and various state chapters.
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