Optimal Team Practice: What it is and what it isn’t.

Over the last several years, states around the country have been updating practice laws and passing various elements of Optimal Team Practice or OTP. The most recent of those are Iowa and Maine, where in Maine for example, PAs working in a clinic or hospital where a physician is employed are no longer required to have a practice agreement with a specific physician. 

Optimal Team Practice is team practice.

What is OTP anyway? In short, Optimal Team Practice is a call to:

  • Authorize PAs to practice without an agreement with a specific physician—enabling practice-level decisions about collaboration.
  • Create separate majority-PA boards to regulate PAs, or give that authority to healing arts or medical boards that have as members both PAs and physicians who practice with PAs
  • Authorize PAs to be directly reimbursed by all public and private insurers

And lastly:

Being able to practice without an agreement with a specific physician sounds a lot like independent practice, doesn’t it? Yes and no. PAs have great respect for the depth of physician training and rely on the PA-physician team in clinical practice. PAs simply want to remove the requirement for a PA to have an agreement with a specific physician in order to practice. This also removes physician liability for the care that PAs provide and reduces physician risk of disciplinary action for administrative reasons unrelated to patient care.

Secondly, does any clinician truly practice independently of other members of the healthcare team? I sure hope not! PAs will continue to be legally and ethically obligated to consult with and refer patients to physicians based on the patient’s condition, the standard of care, and the PA’s education and experience. It’s about finding the…optimal….team-practice. 

PAs seek practice-level decision making when it comes to issues of supervision. State laws should not dictate to physicians how many PAs they may collaborate with or which charts must be co-signed. Those decisions should be made at the practice level, where the care is being provided.

Why are PAs seeking Optimal Team Practice?

Why are PAs seeking Optimal Team Practice? Because the job market is changing and patient care demands it! Financial incentives for physicians to supervise PAs are changing. Where most physicians once owned their practice and employed the PA directly, those numbers have decreased by nearly 40% in the last 30 years. 

Now as hospital employees, physicians don’t want to accept liability for the PA because they shoulder the administration and liability burden while the hospital reaps the financial reward. This is especially problematic in the 20+ states where nurse practitioners have “independent practice” under the Board of Nursing. Florida recently joined the ranks of independent practice for NPs but PAs were somehow left out of the discussion. In a 2017 AAPA survey report, 45% of PAs say that they have already personally experienced NPs being hired over PAs due to outdated supervision requirements. A 2016 article in the Journal of Healthcare Management showed that clinic CEOs make hiring decisions based on economics and practice laws, not training, experience, and patient care. 

What OTP is not.

So, what isn’t Optimal Team Practice? OTP is not:

  • A call for independence 
  • A push for expanded scope
  • Anti-NP or anti-physician

Optimal Team Practice is good for everyone. Patients will have greater access to care. Physicians will be relieved of unnecessary administrative and legal burdens. And PAs will be able to practice to the full extent of their education, training, and experience.

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