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News & Press: SDAPA

Optimal Team Practice

Sunday, October 15, 2017  
Posted by: Louise Papka
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Optimal Team Practice:

Earlier this year, AAPA adopted new policy, referred to as Optimal Team Practice (OTP), which is intended to enhance the ability of PAs to meet the needs of patients and ensure the future of the profession in a changing healthcare marketplace.  The new policy, reflected as revisions to AAPA’s Guidelines for State Regulation of PAs, seeks changes to laws and regulations to:

  • Emphasize PAs’ commitment to team practice, with the degree of collaboration determined at practice level
  • Eliminate legal requirements for PAs to have a specific relationship with a physician in order to practice
  • Authorize PAs to be directly reimbursed by all private and public payers
  • Create autonomous majority-PA boards to regulate PAs, or give authority to healing arts or medical boards to have PAs as members.  Currently in South Dakota PAs are represented on the Physician Assistant Advisory Council to the SDBMOE

The new policy became increasingly necessary for two main reasons.  First, research shows that PAs provide high quality care.  So the provisions included in early PA state laws to assure quality – like specific physician oversight and responsibility requirements – are outmoded and unnecessary.  Second, the healthcare marketplace has changed dramatically.  PAs are now increasingly disadvantaged in the marketplace compared to nurse practitioners (NPs), who have full practice authority in 22 states and D.C.  South Dakota is one of those states.  Given that more and more physicians are employees rather than employers, there is less incentive for physicians to sign a supervisory agreement with a PA.  

The PA profession is projected to grow another 30 percent through 2024.  However, if OTP is not adopted, demand for PAs and PA salaries (relative to NPs) maydecline because NPs are increasingly able to practice without a physician supervisory agreement.  PAs may still be able to get jobs, but they may not be able to compete for the best jobs at the highest salary levels. 

Under OTP, early career PAs, as well as PAs who are switching specialties, would practice in teams with physicians and be supervised just like anyone starting a new job.  And just like every PA, their scope of practice would be determined at the practice level, consistent with the PA’s education, training and experience.  However, under OTP, a supervisory agreement would not be required by state law. 

OTP is not independent practice. Under OTP, PAs wound continue to collaborate with physicians and other qualified medical professionals as indicated by the patient’s condition and in accordance with the PA’s education, training and experience, and the standard of care.  Team-based practice is the hallmark of the PA profession and its educational programs.  The term “independent practice” suggests that PAs would work without the benefit of physicians or other providers for collaboration, consultation or referral.  Under OTP, even if a PA practices in a remote location, they would be obligated to consult with and refer to other providers as a patient’s condition requires. Physicians remain important partners to PAs and PAs will always have close working relationships with physicians.

Although AAPA has adopted this new policy, this does not change how South Dakota PAs practice right now.   SDAPA is still evaluating what our legislative action plan is for 2018 and would like to hear from you.  We have put together a Task force to evaluate what Optimal Team Practice might look like in South Dakota.  The task force will be contacting you with a survey in the next few weeks.  We have also established a legislative fund and ask for your help with donations to the fund.  Look for a link on the new website after launch for more information about Optimal Team Practice and how to donate to the SDAPA legislative fund.  Contact with any questions or feedback.

You may also visit for additional information about Optimal Team Practice.