New Hampshire legislated an artificial barrier to entry when it imposed bureaucratic requirements on our Physician Assistants (PA), which are not imposed on Nurse Practitioners. Since the imposition of a requirement to have a signed collaboration agreement with a physician — a requirement not demanded of nurse practitioners — at least two large physician groups have been outplacing PAs.
As with any barrier to entry, fewer people will ultimately be in the labor pool, which will negatively impact pricing.
This Thursday, the New Hampshire House of Representatives has an opportunity to help ease the healthcare workforce crunch when it considers HB 1222. The bill removes an outdated licensing requirement for physician assistants (PA) applicable only to PAs and not for other healthcare providers such as nurse practitioners.
The clinical PA practice has evolved from when they functioned more as assistants to physicians to their current practice. PAs practice medicine as critical members of modern healthcare teams in care settings of all kinds today. I’ve seen this firsthand, from Afghanistan to Korea, with PAs running medical clinics throughout our military structure in both peace and war.
These professionals deserve the respect they have earned.
PAs can only practice in New Hampshire if they obtain a “collaboration agreement” signed by a physician and kept on file at the PA’s place of employment. This requirement comes from the decades-old concept that PAs are “supervised” by a physician. We know PAs are not directly supervised and provide care autonomously, consulting with physicians or other members of their teams as needed to ensure patients get the care they need.
Advanced practice registered nurses, more commonly known as nurse practitioners (NPs), function in much the same way as PAs. Although PAs and NPs have differences in their education and clinical training, the bottom line is that by the time they are ready to enter the workforce, they are equivalently prepared and qualified.
As PAs and NPs progress in their careers, their experience and qualifications remain comparable, allowing them to be integral parts of healthcare teams and be qualified for the same positions.
So, why are PAs in New Hampshire now routinely being passed over for jobs in favor of NPs?
The answer is simple: PAs need a collaboration agreement to work, and NPs do not. In fact, in New Hampshire, for decades, NPs can receive their license to practice from the moment they finish NP school without any collaborative or supervisory requirement.
While not the norm, a licensed PA in Wyoming practices without a collaboration agreement as soon as they graduate.
For many years, healthcare employers in our state have preferred to hire NPs to avoid the regulatory, legal, and cost burdens associated with having doctors sign the vestigial form of supervisory agreements. Two years ago, the legislature tried to address the barriers to PA employment when SB 228 was unanimously passed and signed into law.
That bill did a few important things. First, it removed the archaic concept of physician “supervision” from our laws and regulations to reflect that PAs are not supervised when they practice medicine. Second, it said doctors can no longer be held liable for care provided by a PA simply because they sign a collaboration agreement. Put another way, the doctor’s signature on the form is without value or purpose.
Third, it made clear that insurance companies can reimburse PAs directly for services they provide. That is, PAs shouldn’t have to bill under a physician, when the care provided by a PA is likely less expensive, and the physician had nothing to do with rendering the care.
Unintended consequences emerged. Some major healthcare employers simply will not hire PAs. They will only hire NPs because NPs don’t need a physician to sign collaboration agreement – a useless document that sits in a file cabinet.
HB 1222 would remove the need for a discriminatory collaboration agreement that adds no clinical value and puts PAs at a competitive disadvantage in hiring and retention.
HB 1222 addresses the concern about collaborating with their healthcare teammates – something that is already an integral part of a complex healthcare environment.
Some erroneously make this a debate comparing PAs and doctors. The meaningful discussion is about the similar training and qualifications of PAs and NPs, and why these two provider types are treated differently under state law.
The legislature should eliminate the artificial barrier to full professional partnership of PAs in our healthcare system and to compete for jobs without the burden of an archaic regulation from a bygone era in healthcare delivery. I urge my colleagues to join me in supporting HB 1222 on Thursday.
