2017 American Academy of Physician Assistants House of Delegates: Where the Rubber Meets the Road.

The May conference of the American Academy of Physician Assistants (AAPA) was a real barn-burner, with lots of action at the always-compelling House of Delegates (HOD), where policy lives and dies for the academy. The House of Delegates meets for three days, with almost 300 representatives from all states, specialty organizations, and caucuses. While many PAs I know would rather drink a pint of cod-liver oil than attend HOD, I’ve been going and participating for most of my career as a PA, and find it inspiring to be with so many PAs who care so much about our patients and our profession.

As always, there was the mix of hot-topics with some of the more bread-and-butter policy issues. This year two of the hot-topics dealt with the always controversial recertification process, a battle that is being waged in many other medical associations as well. Of recently there has been escalating tension between the AAPA and the National Commission on Certification of Physician Assistants (NCCPA), the independent certifying body of PAs. One of the key issues of contention has been the issue of “high-stakes” testing, which has been the tradition in PA profession, with a primary care focused recertification exam taken originally every six years, now moving to every ten. Many PAs have been advocating for a move away from this process, using CME instead for recertification. People on both sides of this issue have their own data to lean on, but those who oppose continued high-stakes testing for recertification often note the there is little convincing data showing that such testing is any more effective in maintaining ongoing medical knowledge than traditional CME.

Additionally, a very explosive issue this year was concern about the NCCPA lobbying against efforts by PA state chapters who are working to modernize PA practice acts. A recent event in West Virginia really got things to a boiling point. There, the state chapter was successful in having modernized rules and regulations passed by both legislative houses, only to have the bill vetoed by the governor after the NCCPA came in and testified at the last minute, opposing the new legislation. Their concern was that the legislation would allow PAs alternatives to recertification other than through the NCCPA.

Things got nasty, and the result has been a very splintered and polarized relationship between AAPA and NCCPA. AAPA has been loudly proclaiming that they will consider finding a new certifying body, and NCCPA has not exactly tried to make peace. However, many of the academy’s elder and leaders have been stepping into the fray, trying to get both sides to calm down and work for solutions instead of blowing the whole process up. And there has been some softening recently by NCCPA, who is now loudly declaring that they are exploring alternatives to the high-stakes recertification tests. Hopeful cooler heads will prevail and the AAPA and NCCPA will sit down and work it all out.

Another hot topic (full disclosure: this resolution came from my specialty organization Society of PAs in Addiction Medicine) was a resolution supporting alternatives to mass deportation, noting the negative health impact of deportation efforts on families living in America. Often with issues such as this, there is a concern on the part of some that these issues are “political” and not “medical,” but this year the HOD was of the mind that it is appropriate for medical associations to take stands on issues that impact the health of their patients, whether they are “social” or not. Two related resolutions passed without much kerfuffle, evidencing the maturing of the PA profession.

Perhaps the biggest high-profile topic this year was discussion about the future of the PA profession, examining ways to remove barriers that prevent PAs from fully being utilized while preserving the deep and historical traditions of the PA-MD team concept. Discussion was civil, and in the end, there was consensus that this is a topic that will need broad consideration from all fronts in the years ahead, and where consensus will be necessary.

Finally, the three-day HOD ended with a champagne toast to the fiftieth anniversary of the PA profession, which was a fitting end to a very productive HOD.

(This was originally posted in the State of Washington Medical Quality Assurance Commission summer Newsletter “Update!” at http://www.doh.wa.gov/Portals/1/Documents/3000/MedicalCommissionUpdate!Summer2017.pdf)

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