Title Change Investigation

Why is AAPA undertaking a Title Change Investigation (TCI)?

At the May 2018 AAPA House of Delegates (HOD) meeting, a resolution passed requesting that the AAPA Board of Directors (BOD), “contract with an appropriate independent consulting/research firm(s) to investigate state/federal, financial, political, branding aspects, and alternatives to the creation of a new professional title for physician assistants that accurately reflects AAPA professional practice policies…”

What was the goal of the TCI?

The overarching goal of this project was to position PAs to successfully compete in the ever-changing healthcare marketplace by boosting the profession’s relevance and impact among stakeholder groups, especially patients, now and in the future.

What was the process and conclusion of the TCI?

Please refer to the November 2020 Final Report to the AAPA House of Delegates, which includes input from WPP, the firm hired to conduct the investigation (to include Kantar, Kantar Research, and Landor); AAPA, the national professional organization; and Foley & Lardner LLP, AAPA’s external legal counsel.

Title Change Vote: 2021 AAPA House of Delegates Meeting

What is the AAPA House of Delegates and why did they discuss the title change at their meeting?

The House of Delegates (HOD) is the policy-making body of AAPA, responsible for enacting policies establishing the collective values, philosophies, and principals of the PA profession. This authority is delegated to them under AAPA’s Articles of Incorporation. The HOD is comprised of elected representatives from 57 state and federal service chapters, 26 specialty organizations, 10 caucuses, and the Student Academy.

The formal title of the profession is acknowledged in an AAPA policy. Therefore, it was the responsibility of the HOD to consider any changes to this policy.

It was the 2018 HOD that passed a resolution requesting that the Board of Directors “contract with an appropriate independent consulting/research firm(s) to investigate state/federal, financial, political, branding aspects and alternatives to the creation of a new professional title for physician assistants that accurately reflects AAPA professional practice policies.”  This policy resolution initiated the Title Change Investigation, which concluded with an extensive report to the 2020 House of Delegates. At that meeting, delegates were charged with returning to their respective constituencies to begin the next phase of this process – discussing the current policy that titles the profession “physician assistant” and returning to the May 2021 HOD Meeting with any proposed changes to that policy.

What was the resolution the HOD voted on?

HOD delegates, board members, representatives of PAEA, ARC-PA & NCCPA and AAPA members met in a reference committee hearing on May 21, 2021 to debate and discuss proposed resolutions. On May 24, the AAPA House of Delegates (HOD) passed a resolution affirming “physician associate” as the official title of the PA profession by a majority vote of 198 to 68.

Next Steps for the Profession

What happens next?

The AAPA Board of Directors will deliberate next steps relating to implementation of HOD policy on title change. AAPA members and nonmembers will be updated as this process unfolds.

Can the AAPA Board of Directors overturn the decision of the HOD regarding the title change?

No. Per AAPA Bylaws, Article VII, Section 1(j), the role of the Board of Directors is: “To review and determine, on no less than an annual basis, how to implement those policies enacted by the House of Delegates on behalf of the Academy that establish the collective values, philosophies, and principles of the PA profession. If it determines that implementation of one or more such policies will require an inadvisable expenditure of Academy resources, or is otherwise not presently prudent or feasible, the Board shall, at its earliest convenience, report to the House the reasons for its decision.”

What is the timeline for changing the title?

A great deal of planning is now required in order to implement the decision to change the title as implementation requires a significant commitment from the profession and its associated entities in terms of financial obligations, resource allocations, and legislative and regulatory efforts. More research and conversations need to occur before a timeline can be finalized. For more details on a potential 5-year implementation timeline and estimated costs, please refer to the November 2020 Final Report to the AAPA House of Delegates.

What will the estimated cost be?

The estimated cost in the final Title Change Investigation report is $21.6 million. This estimate was based on discovery, research, and environment at the time of publication. For details, please refer to the Financial Impact Analysis section of the November 2020 Final Report to the AAPA House of Delegates, pg. 81-85.

Can PAs start calling themselves “physician associates” now?

AAPA’s legal counsel, Foley & Lardner LLP recommends that PAs refrain from representing themselves as “physician associates” at this time. Our view is based on the following:

• Implementing the new HOD policy is going to be complex, challenging, and take many years to complete. There are many intertwined considerations that require thoughtful due diligence to ensure we do not jeopardize any aspect of implementation. It would be unwise for the profession to appear to be out in front of state and federal legislatures and regulators. The next few years of work will be critical and must be strategically undertaken. Winning and keeping allies will be essential. The profession should not do anything to make this already-challenging process harder.
• Prematurely using the term “physician associate” may be viewed as confusing to patients and could be interpreted as the PA stepping beyond the scope of their current license. This could subject the PA to a regulatory challenge or discipline from their state licensing board or an attorney general’s office action. Other professions looking to hold back the PA profession may seize upon such premature usage to file complaints with the regulators.
• Employers or healthcare facilities where the PA has privileges could view the action as a violation of policy, procedure, or professional staff bylaws.
• There may be professional malpractice issues if adverse outcomes are linked to perceived “informed consent” violations from patients who claim they believed they were being treated by a physician. A malpractice insurer could use this as an excuse not to cover the claim.

How will AAPA educate the public about the title change?

AAPA will create a branding campaign to educate all stakeholders on the new title. This campaign will demonstrate the vital role that PAs play across the healthcare landscape. It will likely include media relations, advertising, communications toolkits for our key audiences, and more – with the goal of facilitating brand awareness around the PA role in healthcare.

It’s also vitally important that all PAs take part in showcasing the PA brand. Brand can be reflected in those very personal and caring conversations you have with a patient, and then that patient shares with their friends, family, and colleagues. Here are some more examples of how a brand might be showcased:

• Brand is the stories shared via earned media or paid media focusing on medical interactions a patient has had with a PA that has resulted in successful treatments in conjunction with real compassion.
• Brand is showcasing a PA on a panel of experts at a hospital conference where s/he is providing perspective, learnings, and education on how the healthcare system can deliver high-quality care to patients.
• Brand is a media story featuring a PA working with an indigenous population in Alaska, bringing preventive care to a place in the U.S. that has been ignored – providing these patients with the hope that they too can lead healthy lives.
• Brand is a social influencer or entertainer who is your patient – and they tell the story of how the best value in healthcare needs some attention. The PA, who has been part of their healthcare team, is the one who made the biggest difference in their care. Their true partner in wellness.
• Brand is a major network interview with a PA astronaut and her thoughts around the future of healthcare.
• Brand is partnering with corporations or medical celebrities who can amplify PA voices and tell your stories to bigger audiences.
• Brand is sitting on an esteemed National Panel at a revered medical organization to represent the profession on a body of work that will impact the way primary care is delivered.
• Brand is research (AAPA or PA) that provides insights into how mental health can best be addressed with patients during well visits.
• The PA brand is who you are and what you do each day to deliver on your purpose. Those interactions, stories, and your devotion to your patients will serve to educate and elevate the PA role in healthcare.

How will this affect the pursuit of other AAPA priorities like Optimal Team Practice (OTP)?

Pursuit of legislative initiatives such as OTP will continue to be determined by PA state chapters. Each state chapter will make its own determination about pursuing the title change and elements of OTP. OTP remains a top priority of AAPA and funding for state chapter grants will be evaluated in this process.

How does the title change affect AAPA’s 2021-2025 Strategic Plan?

In developing the plan, AAPA made sure the strategy was flexible enough to enable us to pivot as necessary to account for the variety of possible outcomes with both the Title Change Investigation and Optimal Team Practice.

Do PAEA, NCCPA and ARC-PA agree with this change?

Each organization prepared a report for the HOD on the impact of a potential title change on their respective organization. Each organization will make its own decision about implementation. AAPA is committed to working with all PA organizations to ensure ease and accuracy of adoption.

Do AAPA’s Constituent Organizations have the choice not to pursue the title change?

It is ultimately up to the constituent organizations to decide to adopt or not. AAPA does not have the authority to force a title change on any individual or organization.