TESTIMONY OF THE MAINE MEDICAL ASSOCIATION

NEITHER FOR NOR AGAINST

L.D. 1660, AN ACT TO IMPROVE ACCESS TO PHYSICIAN ASSISTANT CARE

Joint Standing Committee on Health Coverage, Insurance & Financial Services
Room 220, Cross State Office Building, Augusta, Maine
Wednesday, May 8, 2019, 2:00 p.m.

Good afternoon Senator Sanborn, Representative Tepler, and Members of the Joint Standing Committee on Health Coverage, Insurance & Financial Services.  My name is Amy Madden, and I am a family physician and geriatrician at Belgrade Regional Health Center.  I also serve as President-elect of the Maine Medical Association (MMA).  I am here today to present the MMA’s testimony “neither for nor against” L.D. 1660, An Act to Improve Access to Physician Assistant Care.

The MMA is a professional organization representing more than 4300 physicians, residents, and medical students whose mission is to support Maine physicians, advance the quality of medicine in Maine, and promote the health of all Maine citizens.

The MMA has considered its position on L.D. 1660 very carefully and our testimony “neither for nor against” should not be interpreted as one of “neutrality” or “disinterest” in the licensure and regulation of physician assistants (PAs).  MMA members have a strong interest in L.D. 1660; differing opinions within our membership present us with considerable challenges as a membership organization.

By the very nature of the PA profession, PAs and physicians have formed close, collaborative, and collegial relationships serving the people of Maine for many years.  The MMA has enjoyed a close relationship with the Maine Association of Physician Assistants (MEAPA) in which MMA provided an administrative home for MEAPA and involved its members in our legislative advocacy for over a decade.  Maine physicians value their relationships with PAs, and the MMA has appreciated its positive working relationship with MEAPA. 

Based on this foundation, the MEAPA leadership and legislative counsel have engaged MMA in a conversation about this bill and the PA profession’s rationale for it.  The MMA has appreciated the dialogue, and we would like to make it clear that the MMA is open to a continuing dialogue through this Committee’s process of working L.D. 1660 to reach common ground for all stakeholders. The MMA membership has a variety of opinions on L.D. 1660 as drafted, but all would agree that the bill presents a fundamental change in the state licensure and regulation of the PA profession and the role of PAs in relation to physicians, advance practice registered nurses (APRNs), and a variety of other licensed and unlicensed assistive personnel in our dynamic health care delivery system.

Because L.D. 1660 proposes significant changes to the statutes on the PA profession, the MMA strongly encourages the Committee to carry this bill over to the Second Regular Session. This would give stakeholders an opportunity, with either formal or informal guidance from the Committee, to review the bill draft and address issues of concern.  While MMA wishes to exclude no organization that claims an interest in the bill, we would identify the following as key stakeholders in this process:  MMA, MEAPA, the Maine Hospital Association, the Maine Osteopathic Association, the Maine Primary Care Association, the Maine Academy of Family Physicians, the Maine Nurse Practitioner Association, the Board of Licensure in Medicine, the Board of Osteopathic Licensure, the Board of Nursing, and the Commissioner of Professional & Financial Regulation.

We at the MMA have heard our MEAPA colleagues in stating the rationale for this bill:  that the current state licensure and regulation of PAs is outdated, is not efficient in the current delivery system, and is putting PAs at a competitive disadvantage with their APRN counterparts with whom they compete for hiring and promotion in the workplace.  On the other hand, with a major legislative initiative like this, our members have raised questions and concerns too many to mention in brief testimony before the Committee. 

To give the Committee a sense of a few of the concerns in the bill identified by MMA members, I will mention one conceptual issue and one technical issue.  The conceptual issue relates to my opening comments that this bill presents a fundamental change in state licensing and regulation of PAs.  L.D. 1660 would replace the current 1:1 physician/PA direct supervisory relationship with a “collaborative” relationship whereby a PA could provide medical services through collaboration or consultation with a variety of physicians depending on the practice environment.  Some MMA members see this as modernization of state licensure and regulation of PAs, while other members see this as independent practice for PAs.

Beyond the conceptual issue identified above, MMA members have expressed concern about a technical aspect of the bill – it does not provide for any period of direct supervision before a newly-trained PA could move into a “collaborative” practice arrangement.  In comparison, following medical school, physicians in Maine are required to complete at least 3 years of supervised residency with increasing levels of autonomy and supervision of other team members before they are considered fully competent.  In Maine, APRNs have a 1500-hour requirement of direct supervision for new graduates pursuant to Board of Nursing Rule Chapter 8.  L.D. 1660 includes no similar requirement for PAs. 

The Maine legislature is not considering L.D. 1660 in a vacuum.  You will be hearing from many other organizations about the proposal. It is based on model legislation and policy from the American Association of Physician Assistants, entitled “Optimal Team Practice.” The American Medical Association and other physician organizations have policy statements and comparative state law charts which the MMA would be pleased to provide for the Committee’s work session. 

Thank you for considering the views of the MMA on this significant piece of health care legislation.  I would be happy to respond to any questions you may have.