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STATE OF THE AAPA AND FUTURE OF THE PHYSICIAN ASSISTANT PROFESSION

The mission of the American Academy of Physician Assistants is to promote quality, cost effective, and accessible healthcare, as well as the professional development of the Physicians Assistants.

Welcome to the Clinicians Roundtable. I am Lisa D’Andrea Lenell and joining me today is Bill Leinweber, the New Executive Vice President and Chief Executive Officer of the American Academy of Physician Assistants, the AAPA, to give us an update on the state of the AAPA and the goals with the future of the PA profession.

LISA D’ANDREA LENELL:

Bill, welcome to ReachMD. It is a pleasure to have you on the show.

BILL LEINWEBER:

Lisa, thank you for the opportunity. It's great to be with you and the listeners.

LISA DANDREA LYNELL:

Bill, the Academy is in its fortieth year and since you have come on board at the AAPA, many of the more local PAs feel that you are helping to provide a new phase for the academy in new times. Tell us about the state of the AAPA and your philosophy in moving forward.

BILL LEINWEBER:

Well, I arrived at the AAPA in mid February of 2008, and upon arriving began to do some assessment of internal infrastructure issues of the academy looking at our personnel management system, organizational structures, our information technology systems, communications, fairly everything from an operational standpoint from nuts to bolts and these really, the findings from all of these assessments have really been a guide posed for a lot of the efforts we have been undertaking to strengthen the operations of the academy with the goal to be a more efficient, effective, and visible voice in presence for PAs throughout the country. Independent of that assessment phase of our work, we have been engaged in a very thorough strategic planning process, which has been led by the President of the AAPA, Cindy Lord who is a PA that directs the PA program at Quinnipiac University and we initiated that process shortly after I came on board in February and the strategic planning process will come to fruition here in the next month or so. We have engaged about a little over a 100 stakeholders, members, PA members, elected leaders of the academy, senior management in drafting a 3-year plan for the organization and while its not finalized, they can tell you that the broad goals that will emanate from the plan will address where we want to move the academy over the next 3 years in terms of our advocacy efforts, in terms of research on the profession, and the workforce that the profession represents as well as the impact the PAs have on healthcare outcomes, goals that speak to extending our reach to our members, some marketing and branding goals, as well as revenue generation, and constituent organization development. All this is again with the goal for us to really be able to fulfill our mission, which you stated at the beginning of the program and to be the best organization we can be so that PAs can do what they do best, which is to provide excellent healthcare.

LISA D’ANDREA LENELL:

How well positioned is the profession to respond to today’s healthcare provider shortage?

BILL LEINWEBER:

I would say well positioned as most of your listeners know the profession in relative terms is young; 1967 was when the first class of PAs graduated at Duke University. There were 3 PAs in that class and today there are almost 74,000, clinically practicing PAs and that’s increasing fast. The number is growing. The number of PA programs across the countries now, I believe, at 142 programs putting out about 4800 graduates a year. The career is an attractive choice for individuals that have a desire to practice medicine, it pays well; our latest research indicates that the median salary is about $89,000 a year. The average length of education for a PA is about 26 months, which in the spirit of the real genesis of the profession puts individuals into the practice of medicine much more quickly than medical school does. One of the big goals of the physician assistant healed and movement is to extend the reach of medicine in a very efficient and in an effective way and certainly we feel the profession is doing just that.

LISA D’ANDREA LENELL:

Well, in addition to the projected shortage of primary healthcare professionals, there’s also a demand for providers in other specialties. How are PAs meeting the increasingly diverse needs of the healthcare system in terms of their role in medical and surgical specialties?

BILL LEINWEBER:

Well, you’re right. There’s a lot of discussion these days both in the medical literature and the popular press regarding the shortage of primary care physicians today and the projected shortage moving forward. Similarly, there are shortages in specialty fields in medicine as well. In the past, PAs put a lot of attention to serving the needs in primary care particularly in underserved communities, rural communities, and intercity communities to really extend the reach of medicine where there were not physicians present to do so. The trend over the past decade shows that an increasing number of PAs are practicing in medical and surgical specialties, although I think its important to point out that still about 35% to 37% of PAs still practice in primary care. The generalist model of PA education, we believe, provides a solid foundation for PAs to enter medicine in a variety of medical and surgical specialties. There is a strong foundation that offers flexibility of PAs in training where they do multiple rotations across numerous areas in medicine and allows new graduates to move quickly and easily into specialties and really as you know, Lisa, being a PA that once graduated and successfully completing a PA program and being placed in the practice, there is very much an ongoing training and mentorship that goes on between a PA and his or her physician colleagues, which really continues that training process. If the profession moves towards a more specialty diverse practice distribution, the long existing controversy surrounding PA specialty certification is one that we are remaining in close dialogue and contact with the NCCPA about this as an hot button issue if you will and the profession, the commission, and all of our partner organizations are really committed to working together to see how we can best address this moving forward.

LISA D’ANDREA LENELL:

If you are just joining us, you are listening to the Clinicians Roundtable. I am Lisa D’andrea Lenell and I am speaking with Bill Leinweber, the new Executive Vice President and Chief Executive Officer of the American Academy of Physician Assistants. We are discussing the state of the AAPA and the goals for the future of the PA profession.

Bill, what do this year’s election outcomes mean for the work of the academy and the PA profession?

BILL LEINWEBER:

Well, first certainly want to thank all of your listeners that voted for voting. It was a great and exciting time for the country and really a real moment in history for the nation. We have launched an initiative at the start of our annual conference at the end of May called PAs for a Healthy America that really encouraged PAs to learn all that they could about candidates for the office of President as well as their candidates for a congressional and senate seat in the localities and states that they represent. We look forward to working with the new administration in Congress. We will be in touch very soon with President Elect, Obama, and appropriate members of his transition team to congratulate him and to articulate a desire of the academy to be at the table working with the President Elect and his team of healthcare reform folks because we believe both, because we know what PAs are capable of providing in terms of healthcare. We are also encouraged by the responses of the President Elect, Obama, provided to us at our request prior to the election. We reached out to both Senator Obama and Senator McCain and asked them to share their points of view relative to where PAs fit into the healthcare system broadly and how they would see PAs interfacing in their proposed healthcare reforms. We were encouraged by what we heard back from both candidates and certainly from President Elect, Obama, we look forward to working with he and his administration. The principles that we have been promoting in terms of healthcare reform will be ones that we continue to promote and those include access to quality, affordable cost effective healthcare, use of evidence-based medicine, physician directed teams of healthcare providers, PAs remains steadfast in our commitment to the healthcare team model with the physician leading the team, optimal utilization of primary care, an emphasis on health promotion and disease prevention, comprehensive medical liability reform, and lastly, but very importantly payment mechanisms that are portable and sustainable.

LISA D’ANDREA LENELL:

Going forward, what specifically is on the academy’s legislative agenda?

BILL LEINWEBER:

A couple of things that I think would be of interest to your listeners. Certainly, on the topic of expanding access to affordable healthcare, a central component of our mission is to promote quality and cost effective and accessible healthcare. So we favor reforming the nation’s system to emphasize prevention and use of evidence-based medicine and portable financing a huge issue, as you know Lisa, in terms of prevention is that reimbursement systems in this country are not necessarily in their current state prevention friendly. We would really reward and incentivize treating individuals once they present with sickness or illness or symptoms. We really would like to reverse that in part and incentivize prevention. Secondly, we are looking at ensuring access and continuity of care for Medicare beneficiaries. The Medicare law, we believe, should be changed to allow physicians to delegate to PAs the ability to order home health, hospice, and skilled nursing facility care as well as to provide hospice care. This is becoming a growing issue with our aging population and increasingly we see a lack of continuity of care, interruption in continuity of care because the PAs are not able to do this under current Medicare law. Thirdly, want to acknowledge is the value and role of federally employed PAs. Part of our legislative agenda is to promote legislation to place a full-time director of PA services in the Veteran’s Health Administration Central Office in Washington DC so that PAs working in the VA system can be utilized to their fullest capacity if they care for our nation’s veterans. The VA is the federal government’s largest employer of PAs and we believe really necessitates the full-time director of PA services. Lastly, we want to promote access to care in underserved communities that really takes the profession back to its roots in terms of extending the reach of medicine into underserved communities. We have a long-standing commitment to practice in the nation’s rural areas and underserved urban communities. We support legislation that strengthens the State Children’s Health Insurance Program, Medicaid, Rural Health Clinics, and other components of the safety nets. Those are the main issues on our legislative agenda. I would identify as a final issue, Lisa, in terms of our legislative agenda working with the Health and Senate Committee on appropriations to develop strong, robust, sustained levels of funding for the Public Health Service Acts, Title 7 Health Profession Program. Unfortunately, the legislation was approved to establish the FY 2008 appropriations for the Department of Labor, Health, and Human Services and related agencies has not been sufficient to address the Title 7 Health Profession Program’s needs. We really need to grow support for the PA program components of Title 7 and we are committed to doing that.

LISA D’ANDREA LENELL:

Bill, we look forward to your future leadership and thank you so much for coming on this show.

BILL LEINWEBER:

Thank you very much.

LISA D’ANDREA LENELL:

I am Lisa D’andrea Lenell and you have been listening to the Clinicians Roundtable on ReachMD XM 160, The Channel for Medical Professionals. Please visit our website at www.reachmd.com, which features our entire library through on-demand podcasts and thanks for listening.