WHA testified in support of SB 515
, legislation establishing a new physician assistant licensure statute championed by the Wisconsin Academy of Physician Assistants, at the state Senate Committee on Elections, Ethics, and Rural Issues on Jan. 15.
Under the bill, physician assistant staffing ratios and physician presence licensure requirements would be eliminated, but physician oversight of individual physician assistant practice would be retained in the licensure statute either through employment or a written collaborative agreement.
The bill also addresses inconsistent physician assistant delegation provisions that are a barrier to efficient team-based care.
“Advancing team-based care delivery and best utilization of Wisconsin’s health care workforce to advance high-quality, accessible health care are key priorities for WHA’s member hospitals and health systems,” said Ann Zenk, WHA vice president workforce and clinical practice to the committee.
“We appreciate the Wisconsin Academy of Physician Assistants efforts to seek our input on their proposal as early as 2018 and their work to address our concerns and recommendations which have been incorporated into this bill.”
Eric Elliott, PA-C, Wisconsin Academy of Physician Assistants (WAPA) advocacy chair, thanked WHA during his testimony for WHA’s work to help WAPA improve the bill to both preserve quality safeguards and limit regulatory complexity for physician assistants and their employers.
Matthew Stanford, WHA general counsel, shared with the committee the input WHA received from its members, including the WHA Physician Leaders Council made up of hospital and health system CMOs and other physician leaders, on the unnecessary burden current Medical Examining Board rules governing physician assistant staffing ratios and physician presence requirements place on physician assistants, physicians, hospitals and health systems. Following discussions by the WHA Physician Leaders Council starting in 2018, the council in October 2019 reviewed and approved of the current version of the bill.
“The end result was that we are comfortable in supporting this bill as a good balance of reducing the regulatory burden on PAs, physicians, hospitals and health systems, while also preserving the important role of physicians in a team-based care delivery model and other safeguards to preserve high-quality care in Wisconsin,” Stanford said.
Jonathan Truwit, MD – a member of WHA’s Physician Leaders Council – shared a similar analysis of the bill and described his professional observations on physician assistant practice in his testimony supporting SB 515. Dr. Truwit is also Enterprise Chief Medical Officer, Froedtert Health and the Medical College of Wisconsin.
He said that as a practical matter he sees the quality and knowledge of physician assistants and nurse practitioners as interchangeable, yet Wisconsin’s licensure law creates additional regulatory burdens impacting utilization of physician assistants that do not apply to nurse practitioners.
Other physicians and physician professional societies testified and registered opposition to the bill.
Joanna Bisgrove, MD, speaking on behalf of the Wisconsin Medical Society, testified in opposition to the bill.
She suggested that a motive behind SB 515 is to enable hospitals to save money by requiring clinical physicians to supervise more physician assistants, which would place additional, unpaid responsibilities on physicians.
She said that post-Act 10, she became the main breadwinner in her family and that adding additional supervisory responsibilities to her already busy clinical practice would be untenable.
State Sen. Kathleen Bernier (R-Chippewa Falls), chair of the Senate committee hearing the bill and lead Senate author of SB 515, responded to Dr. Bisgrove’s motive suggestion as “reaching for anecdotes.”
Rather than adding to physician burden, Stanford said that the bill’s language regarding employed physician assistant oversight is similar to federal CMS requirements regarding oversight of physician assistants and should enable hospitals and health systems to utilize physician administrators, such as department chairs, to fulfill the physician oversight role in the bill rather than physicians generally.
He said that this is an important clarification that should reduce, not add to, physician practice burden.
Tara Streit, PA-C, immediate past president, Wisconsin Academy of Physician Assistants, added that concerns that the bill would enable hospitals to “run amok” and place new burdens on physicians was “disingenuous.”
“Wisconsin already has no physician supervision ratios for nurse practitioners and no one has raised concerns with that,” Streit said. “Raising that as a concern in regards to [this bill] seems disingenuous.”
Bud Chumbley, MD, CEO, Wisconsin Medical Society, also testified in opposition to the bill. He expressed personal concerns with the quality of “freshly-trained” physician assistants and nurse practitioners and also was specifically dismissive of Dr. Truit’s perspectives on physician assistants and this bill.
Dr. Chumbley did suggest, however, that the bill could potentially be “tweaked” to address physician assistants immediately coming out of training.