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The World is Run By Those Who Show Up

Picture this: a newly elected PA leader is tapped by his state chapter to attend medical board meetings as the chapter's observer. He attends regularly, but one day a conflict arises. He can't find an alternate, so he scrutinizes the medical board's agenda to see if it is critically important to be at this particular meeting. The agenda appears to include nothing relevant to PA practice. Being new at this job, he calls the chapter's lobbyist to see if he thinks it is critical to be at the meeting. The lobbyist concurs - nothing relevant on the agenda - it would be fine for him to miss this one meeting.

But during the meeting, a medical board staff member raises the question of how many supervising physicians a PA should be able to register. The board members, none of whom work with PAs, decide that there should be a limit. Two days after the medical board meets, PAs in the state begin to receive letters stating that a PA may not have more than four supervising physicians.

There are more horror stories like this one from across the nation dealing with topics as wide-ranging as lasers, e-prescribing, aesthetic services and more. No matter the issue, the moral of the story stays the same: you gotta be there.

So add this to your checklist of keys to the success of your state chapter's government affairs program: Your chapter must send an observer to every meeting of the state agency that regulates physician assistants.

This can be a tall order, but it's worth it. Here are ten questions that chapter leaders commonly ask about sending observers to regulatory agency meetings:

1. Our medical board has a PA as a member. That PA can represent the interests of the profession - right?

Wrong. Once the governor taps a physician assistant to serve as a member of the medical board, that PA is there to represent the interests of the people of the state, not just the interests of the state's PAs. Most often those interests are aligned - but not always. Even if there is a PA up front in the swivel chairs, you need to have a chapter observer in the peanut gallery.

2. Our medical board has a PA Advisory Committee. Do those PAs represent the profession?

Nope. Those PAs, once appointed, are there to do the state's business. The profession needs its own spokesperson in the audience.

3. So do we need to send an observer to the meetings of both the PA Advisory Committee and the medical board?

Yes. Issues affecting PA practice can originate in either body.

4. The medical board goes into executive session to deal with licensee discipline. Our observer will be asked to leave during those times. Isn't that a waste of time?

Not necessarily. According to Beth Grivett, PA-C, chair of the California Academy's government affairs committee, being in the hallway or getting coffee with the group of other observers can be quite productive. "The observer for the medical society and I commonly find ourselves on the bench outside the hearing room together. It's a great time to catch up on other issues. It's good to have this established relationship when I need to call the medical society office."

5. We have identified a junior member of our leadership who wants to take on this role, but he is concerned that he doesn't yet know enough about our chapter policies and priorities to do an adequate job. Is that likely to be a problem?

Not necessarily. If asked a question, your representative can easily say, "Good question - I'll need to check with our board of directors and get back to you." Your observer is there to represent the profession - if the best way to do that isn't clear, they need to check in with the board before representing any chapter position. They aren't there to give a personal opinion.

6. Does our representative need to have prepared remarks for each meeting?

Not unless you have something specific to bring to the board's attention. Forty-nine percent of the job of the representative/observer is taking note of the trends and issues that arise in order to alert your government affairs committee and board of directors. Six percent is providing answers to specific questions or providing PA-specific input on relevant topics. And the remaining 45% of the job is just being there as a visual cue to assure that the board is adding PAs to relevant language, policy and initiatives. (Note: 79% of statistics are made up on the spot.)

7. The regulatory authority in our state meets by conference call. Can we still send an observer?

The state has to abide by its own open meetings laws. They must create a method to allow the public to observe the meeting. Find out how your board complies with this, and utilize that mechanism. (In some states this means that your observer must go to the medical board's office and sit in with the staff. That's a good thing.)

8. So how about we skip a step and see if the chair of our government affairs committee can be appointed to the medical board's PA committee?

Sorry. A person - even a great PA - cannot serve in potentially conflicting roles. (See question 2.)

9. It seems that we have so few people willing to get involved. How can we ask our small band of leaders to take on this additional task?

You may need - or more likely, probably need - to look beyond the usual suspects. Think creatively. Is there a junior faculty member who could do this? Are two PAs who work part time willing to share the role? (Note: ideally you will have one or at most two consistent observers. Consistency matters when building relationships.) This can be an ideal leadership development activity. It can also be a great venue for utilizing your elder statespersons. Is there a past president who would be willing to take this on? Remember: the most common reason people give for participating in the work of an organization is that somebody asked them.

10. Okay, we are nearly convinced. What are the ideal characteristics of the person we'll appoint?

Well, as with any appointment you'll want a credible voice in a person who is temperamentally suited for this key role. You want someone who will put a good face on the profession and your organization. You'd like an individual who knows how to disagree without being disagreeable and who is comfortable starting hallway conversations with strangers. Your representative should be a person who the board will find easy to listen to, should they or the staff pose a question.

New Resources

The Six Key Elements of a Modern Physician Assistant Practice Act are presented in this spiffy new issue brief. The attributes PAs bring to practice in retail clinics is outlined in this advocacy brief.

Legislative Watch is a monthly state government newsletter written by Ann Davis, PA-C, AAPA director of State Government Advocacy and Outreach ( e-mail This e-mail address is being protected from spambots. You need JavaScript enabled to view it ; 703-836-2272 ext. 3201). As we enter the season of Thanksgiving all of us on the state government affairs staff are thankful for all of you who toil on the front line of PA state government projects where the work is hard and the harvests unpredictable. Newsletter editors may reprint non-sensitive items from LW if they credit the source using its full name: The American Academy of Physician Assistants' Legislative Watch. Failure to do so will guarantee lumpy gravy.