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Letter to the Editor: PAs are low-risk assets who deliver excellent patient care :

May 24, 2016
No

As president of the American Academy of PAs (physician assistants) and a longtime PA practicing family medicine in rural North Carolina, it pains me to read articles like “Pediatricians and the Law: How to manage liability risks when supervising mid-level providers” in the February issue of AAP News, http://www.aappublications.org/news/2016/01/27/Law012716. Not because PA practice is without risk, but a look at the numbers shows the risk is relatively low.

This style of article is ubiquitous and follows a common construct: Start with a scary introduction about all the terrible outcomes that “might” happen if you practice with a PA. Make the usual credentials assessment sound like PAs need more scrutiny than any other clinical hire or new partner. Imply that PAs have lots of gigantic insurance claims paid against them. End with a list of practical suggestions about how to collaborate effectively and safely with PAs.

Pediatricians would be wise to study the “take home” messages from author James P. Scibilia, M.D., FAAP. It’s the tone of the piece that rankles:

  • “understand state scope of practice limitations … ”

  • demeaning references to “nonphysicians” and “mid-level” providers (We prefer being referred to as “PAs.”)

  • scary references to “supervision obligations

  • a big-ticket liability outlier that doesn’t reflect the modest number or level of liability payments made in cases involving PAs

  • minimize PA education (factually incorrect) and reach an unsubstantiated conclusion that PAs, therefore, “may be more likely to make errors in clinical care.”

Rather than publishing an article using extreme risk examples that might dissuade AAP members from working with PAs, it would be of more service to provide fair, evidence-based risk information along with solid advice about reducing risk by developing good hiring and practice policies.

The typical PA program extends over 27 months (equal to three academic years). It consists of a didactic (classroom) phase and rotations in medical and surgical disciplines for a total of 2,000 hours of supervised clinical practice, more than the 500-800 hours Dr. Scibilia cites.

Virtually all PAs carry liability coverage. Data from the National Practitioner Data Bank show that in 24 years of data collection, only eight payments for PA liability (0.34%) were at the “seven-figure level,” as in the example offered by Dr. Scibilia.

A study reported in the Journal of Medical Licensure and Discipline noted that the probability of making a malpractice payment was 12 times greater for physicians than for PAs.

More than 108,500 PAs practice medicine in the U.S. and work in every medical specialty from primary care to neurosurgery. PAs recognize the value of a cooperative, patient-focused approach to medicine and work together with physicians in a wide variety of settings. They are vital health care providers and low-risk assets who are proven to create access, elevate health outcomes and deliver excellent patient care.

— Jeffrey A. Katz, PA-C, DFAAPA

President and chair of the board, American Academy of PAs

 To submit a letter to the editor email Anne Hegland at ahegland@aap.org

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