The Unadulterated Pros and Cons of Optimal Team Practice

Optimal Team Practice, or OTP, is the term given to a 2017 policy supported by the American Academy of PAs that calls for, among other things, the removal of the state-level requirement for a physician to go on record as the supervisor of a PA. According to the AAPA, “Optimal Team Practice occurs when PAs, physicians, and other healthcare professionals work together to provide quality care without burdensome administrative constraints.” This article will discuss the pros and cons of Optimal Team Practice.

First known as physician associates, PAs have been providing healthcare to Americans for over 50 years. Many other countries besides the US have now followed suit and have developed similar programs for non-physician advanced practice clinicians.

The PA of Today

PAs are autonomous providers–they make diagnostic and treatment decisions independent of other healthcare providers, including physicians. In operating rooms, physician assistants, as they are currently called, assist physicians but in most other settings whether in-patient or out-patient, PAs care for their own patients. 

While it is common, and appropriate, for new PAs to consult more frequently with a collaborating or employing physician, experienced PAs tend to do so infrequently. When unique questions arise, it’s easier and more efficient to speak with the relevant specialist just as any physician would do. 

Patients Need Optimal Team Practice

The biggest pro of Optimal Team Practice is the benefit to patients. Antiquated statutes and policies that don’t reflect the current state of PA practice negatively affect patient care:

• Most states have limits on how many PAs a physician can supervise–this removes well-trained PAs from the workforce. 
• Hiring managers prefer NPs who come with less administrative baggage
• Wait times to see any sort of healthcare provider, let alone a primary care provider can be weeks
• Clinics and hospitals spend more hiring and paying staff to administer the more complex requirements of hiring a PA vs an MD or NP
• Physicians feel burdened with the added liability for patients whom they’ve never seen

But don’t take my word for it. Researchers at the Brooking Institution, Drs. Kathleen Adams and Sara Markowitz clearly see the pros of Optimal Team Practice and have stated that “removing unnecessary restrictions on PA practice, such as eliminating the requirement for PAs to have an agreement with a specific physician in order to practice, would help alleviate healthcare shortages and improve efficiency with no adverse effects on patient outcomes.” 

PAs in Rural Medicine

Another pro of Optimal Team Practice is how it will help those who need it most. In some areas of rural America, PAs may be the only medical provider available. Bill Finerfrock, Executive Director of the National Association of Rural Health Clinics has said, “The changes PAs are seeking represent a natural evolution of the PA profession. Patients, especially in rural and underserved areas, will benefit from greater access to the high‑quality care that PAs provide.”

Several states are in the process of modernizing their practice acts. North Dakota was the first to eliminate the requirement for PAs to identify a specific supervising physician. The Indian Health System also realized the great opportunity this was to streamline patient care and has also removed such requirements throughout their entire network of clinics. 

Are there any cons to Optimal Team Practice? I don’t think so. It’s time to make PAs fully responsible for the care they provide by adopting Optimal Team Practice.