A look at one member of the healthcare team with whom Repertoire readers can expect to interact more frequently in the future
At the end of 2015, the American Academy of PAs (physician assistants) released a white paper that documented four trends influencing healthcare delivery in general, and the PA profession specifically, including:
- Medicine is not what it used to be.
- More patients…more complex conditions.
- Value-based reimbursement is a game-changer.
- The marketplace is driving industry transformation.
Repertoire talked to Josanne Pagel, MPAS, PA-C, president of the AAPA, to discuss the growing roles of PAs in the healthcare system.
Repertoire: The AAPA’s 2015 “Building AAPA’s Strategic Plan” white paper provides the results of a 2015 survey, in which leaders indicated that they believed PAs are adapting well to the ideas that a) “Medicine Is Not What It Used to Be” and b) “More Patients…More Complex Conditions.” How, if at all, do you believe these factors have affected PAs overall?
Josanne Pagel: PAs are rising to meet the new challenges in the healthcare landscape. More patients – many with chronic, complex conditions – are seeking care. Longer lifespans and an aging population are increasing workforce demand, while chronic conditions are escalating the utilization and cost of healthcare. PAs are uniquely suited to meet these challenges because of their advanced training and broad medical knowledge. Today, more PAs are working than ever before. At the same time, there are opportunities to expand the role PAs play in the overall healthcare system.
Repertoire: How, if at all, do you believe these two factors are affecting PAs as a group – “Value-based reimbursement is a game-changer,” and “the marketplace is driving industry consolidation?”
Pagel: We believe the transition to value-based healthcare will translate into an increased reliance on PAs. Consumers are demanding more personalized healthcare in settings like retail clinics and virtual services including telemedicine. In addition, PAs in specialty practices have the general medical education that positions them well to address any co-morbidities. These are the new and emerging models of healthcare. Because PAs focus on quality care and improved patient outcomes, not just administering tests, they are an essential component to a value-based healthcare system. What’s more, consolidation in healthcare has resulted in more providers being employed by healthcare systems as opposed to individual practices. This means PA-physician relationships may be changing.
Repertoire: The white paper states that team-based care will become “the” standard in healthcare. Do you agree? Why or why not?
Pagel: We agree. Team-based care is already how PAs practice healthcare. This is good news for patients and PAs. PAs work in, and often lead, team-based healthcare day in and day out. They work alongside physicians, nurses and other healthcare providers to determine the best course of care for patients. A patient-centered focus is what will help more people get and stay healthy over the long term.
Repertoire: One discussion question in the white paper is, “What makes PAs good team players as compared to other providers?” How would you answer that question?
Pagel: PAs are particularly nimble in the care they can provide. They are trained in the medical model in general medicine but can also specialize in areas including obstetrics and gynecology, internal medicine, pediatrics, general surgery, emergency medicine and psychiatry. Some PAs specialize in more than one area over the course of their career. Many PA programs provide opportunities for inter-professional education during the training process. This means they add value in many different healthcare environments and teams.
Repertoire: Can you please respond to this question from the white paper: “Should the profession be concerned that more PAs are choosing specialty positions over primary care? If yes, why? If no, why not?”
Pagel: Primary care services do remain fundamental to PA practice. There has been a large decrease in the percentage of PAs practicing in primary care (46 percent in 1990 vs. 30 percent in 2015), with substantial increases in surgical (15 percent in 1990 vs. 26 percent in 2015) as well as internal medicine specialization (6 percent in 1990 vs. 11 percent in 2015). However, due to overall growth of the profession, PA presence in primary care remains strong with the absolute number of PAs in primary care tripling over the last 25 years (~10,000 primary care PAs in 1990 vs. ~30,000 PAs in primary care in 2015). Further underscoring the value of the profession’s general medical education, the 2015 AAPA National Survey also revealed that large numbers of specialty PAs report providing basic primary care services in non-primary care specialties. 46 percent of respondents indicated they diagnose patients with conditions unrelated to their specialty and 26 percent indicated they actively treat patients for conditions unrelated to their specialty.
Repertoire: Do you foresee the demand for PAs growing in the future? Why or why not?
Pagel: The demand for PAs is indeed on the rise. In fact, it increased 300 percent from 2011 to 2014. More than three quarters of PAs that have earned certification receive multiple job offers. There has also been an increase in PA programs at colleges and universities across the country. The increased demand reflects the growing role of PAs within the broader healthcare system. PAs continue to fill gaps by expanding access to high quality care for patients where and when they need it most.
Repertoire: How would you characterize the public’s understanding and acceptance of PAs?
Pagel: The overwhelming majority of patients who deal with PAs rate the experience as positive. A Harris Poll found extremely high satisfaction rates among Americans who interact with PAs. The survey found that 93 percent regard PAs as trusted healthcare providers, 92 percent said that having a PA makes it easier to get a medical appointment and 91 percent believe that PAs improve the quality of healthcare. As more and more patients are exposed to PAs, they are coming to depend on them as a vital part of the healthcare system.
Repertoire: How do you think value-based reimbursement – as opposed to fee-for-service – will impact how PAs practice?
Pagel: The value-based reimbursement system is a natural fit for how PAs practice already. PAs have always employed a “patients first” philosophy when it comes to healthcare. They have also been critical to expanding patient access to care. As consumers demand more convenience and value in their healthcare, PAs are helping to provide both. PAs are also extremely cost-effective healthcare providers. They provide high- quality care at a lower cost and are a natural fit for a value-based reimbursement system.
Repertoire: According to the white paper, the changing industry of healthcare brings a need for PAs as leaders with business understanding. Do you agree? Why or why not?
Pagel: Because the healthcare landscape is changing, it’s important for PAs to make sure they are well represented in new economic structures within the industry. That is why ensuring PA contributions and value is properly documented through recognition and billing data is a top priority for AAPA. What’s more, we want to work with employers to establish workplace policies and practices that enable PAs to practice at the top of their education and experience, participate in policy-setting and clinical decision-making bodies and serve in leadership and management roles. PAs who understand the laws governing PA practice and how they are changing will be in the best position to enable optimal PA practice and patient outcomes.
To view the strategic planning white paper referenced in the interview, visit https://www.aapa.org/WorkArea/DownloadAsset.aspx?id=2147485944.