Efforts to make it easier for physician assistants to practice in multiple states are gaining traction, boosting opportunities to recruit and retain both medical professionals and patients.
The PA Licensure Compact gives physician assistants the opportunity to expand their work geographically without having to receive additional state licenses. While it's unlikely to to take effect for another 18 to 24 months, there is already a model for what the compact will look like and offer.
The American Academy of Physician Associates, in collaboration with the Federation of State Medical Boards, came up with the idea of the compact in 2019.
During the height of the COVID-19 pandemic, several states enacted emergency protocols that allowed physician assistants to practice with fewer restrictions, and gave them the ability to move between states with less red tape. Many of those states have returned to their original licensing requirements for physician assistants, leading to renewed interest from states and physician assistants in forming a compact.
As of July, 13 states are in the compact: Colorado, Delaware, Maine, Minnesota, Nebraska, Ohio, Oklahoma, Tennessee, Utah, Virginia, Washington, West Virginia and Wisconsin. Legislation is pending in Michigan, New Jersey and North Carolina.
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The compact requires a commissioner from each participating state to take part in its design and execution. The commissioners are scheduled to meet in September to begin working on the structure, said Meghan Pudeler, director of state advocacy and outreach for the American Academy of Physician Associates.
The biggest hurdle will be creating the data system to include all applicant and state information on one platform, Pudeler said. Physician assistants in participating states will fill out a single application to potentially be able to practice across all states involved in the compact, pending individual state regulations.
Applicants will have to undergo background checks and maintain valid certification from the National Commission on Certification of Physician Assistants.
“The goal here is for it to be more like a one-stop shop, to be able to apply for your different privileges in different states, versus going through each process," Pudeler said.
Despite participating in the compact, states still can set their own requirements for physician assistants, such as the hours of practice required.
The compact's aim is to boost recruiting efforts while expanding access to care by making it easier for physician assistants to practice in multiple states, including through telehealth.
“[This] can really speed things up by many months, if not to upwards of a year in some states, for someone to begin practicing in a new state,” said Jason Prevelige, president of the American Academy of Physician Associates. “I live in Connecticut, and we have several states that touch us and this could easily allow folks to cross borders and provide care, as well as in the virtual health and telehealth world.”
The increased use of physician assistants and nurse practitioners in healthcare remains a concern for some in the industry.
Last month, recently elected American Medical Association President Dr. Bruce Scott said one mission of his tenure was to help make the healthcare industry less reliant on non-physician providers, including physician assistants. Scott said the replacement of physicians has been a large issues in recent years, particularly in rural areas.
Nebraska state Sen. Carol Blood (D) introduced physician assistant compact legislation in January, seeing it as a way to improve rural healthcare access. Similar legislation introduced by state Sen. Ben Hansen (R) was signed into law in April.
“Rural areas have become particularly more vulnerable, with 13 physicians for every 10,000 residents here in Nebraska,” Blood said. “This coverage gap is growing for rural communities with doctors in these areas retiring and not being replaced. The bright spot that emerged during the pandemic was the emergence of telemedicine and the PA compact maximized these benefits.”
Alannah Zheng, legislative and reimbursement committee co-chair for the Minnesota Academy of Physician Assistants, said the compact will help states’ providers financially.
“I definitely think that there's going to be a big financial component because we can retain some of our patients who would otherwise have to seek care elsewhere,” Zheng said. “For example, we have a lot of snowbirds in Minnesota. If we are able to see them via telemedicine, if they're in a compact state, we're able to then retain that patient, which financially for the institution would be a big thing.”
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