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News & Press: SDPA News

Optimal Team Practice

Wednesday, September 5, 2018  
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Originally published in The Dermatologist, August 16, 2018

By, Jennifer Winter, MSPAS, PA-C


The physician assistant (PA) profession has been around for 50 years and PAs are found in all areas of medicine including dermatology. Envisioned to address a shortage of physicians and based on the fast-track training of physicians during World War II, this profession started with former military medics who had a lot of experience, but no civilian opportunities to use that experience.

PAs are trained in the medical model and originally worked with physicians out of necessity. It was a new profession that needed to be nurtured and those early folks had to prove that they could take care of patients safely with their abbreviated training. Fifty years later medicine has evolved more than anyone could have imagined, and the PA profession has indeed proven to be a success. After learning the basics during training, PAs continue to learn in the clinic and hospital just the way residents learn and practice, alongside physicians.

Physicians who needed to increase access to care for patients turned to PAs to address that need. They created a team that worked together for the benefit of the patient. Medicine has become so specialized that team practice is the norm and solo practitioners are becoming rare. As physicians are increasingly employees rather than practice owners, they have less control over hiring decisions about team members such as PAs. Those decisions are being made by administrators who may not understand the training of PAs and their long-standing team approach to medicine and who see only the barriers and paperwork that are required to hire PAs vs other providers. This results in fewer PAs being hired and the profession is now at risk, especially at large hospital systems.

It is those barriers that PAs are seeking to break down in order to continue to have a viable profession. In dermatology, the trend toward corporate practice has been slower than many other specialties, but it is growing. PAs have trouble volunteering and providing care in areas where there are no physicians because of state laws that have not kept up with the changes in the way medical care is provided. Patients have lost access to care when a supervising physician has retired, died, or become unable to practice leaving a PA unable to continue based on current laws.

Because these concerns affect PAs in general, dermatology PAs also support reducing the legal barriers to practice. Optimal Team Practice or OTP, is an idea whose time has come. OTP is a policy adopted by the American Academy of Physician Assistants with a broad vision of the future of the profession. OTP calls for laws and regulations that authorize PAs to practice without an agreement with a specific physician. This removes the physician from the liability for the care the PA provides and places that responsibility back on the individual PA.

The idea behind OTP is not to seek solo independent practice, frankly even physicians are less likely to be independent these days, but to have the decisions about how much autonomy a PA will have made at the practice level rather than the state level. The level of autonomy will vary depending on the experience and training of the PA and the type of patients being cared for.

PAs do not want to change the current PA role, working with physicians, which is well established after 50 years. We value our relationship with physicians, greatly respect their depth of knowledge and training, and wish to continue that partnership. PAs will remain legally and ethically obligated to consult with and refer patients to physicians based on the needs of the patient.

PAs need OTP to remain a viable profession and continue to provide quality care to our patients. We appreciate your support. This is a complex issue; if you would like additional information or clarification, please feel free to contact me directly at 

About the Author:

Jennifer Winter, MPAS, PA-C | Ms Winter is in practice in Olympia, Washington. She is a past president of the Society of Dermatology Physician Assistants and serves as the current chair of the Public Education committee. 


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