IAPA Response to ISMS Letter to Illinois Lawmakers
In a letter to lawmakers, and distributed to physicians and health systems throughout the state, the Illinois State Medical Society (ISMS) made the following, largely false assertions about IAPA’s current efforts to modernize the PA Practice Act.
See the letter and our responses below:
Illinois State Medical Society
“Physicians throughout Illinois respectfully request your “NO” vote on HB 4637, a bill that would negatively impact patient care by removing the collaborative process that patients benefit from currently. “
Illinois Academy of PAs
HB 4637 does not remove the "collaborative process", only the unnecessary mandate that collaboration documents must be filled with the state. Illinois PAs remain dedicated to team-based care with physicians.
“These bills remove the team approach and grant physician assistants independent practice after they complete minimal hours of continuing education and clinical training under the guise of optimal practice.“
HB 4637 does not remove the team approach or grant independent practice for PAs. HB 4637 expressly prohibits PAs from owning a practice, and 225 ILCS 95/5.5 already prohibits PAs from direct billing. PAs want to continue working in a team-based model with physicians.
“For those physician assistants who do not qualify for optimal practice, the bill significantly weakens the collaborative relationship between physicians and physician assistants. Collaborative requirements are substantially diminished, while scope is enlarged without also requiring increased training and education. For example, the bill deletes a requirement that prescriptive authority be delegated by the collaborating physician and would allow physician assistants to prescribe and administer all drugs, including Schedule II narcotic drugs by injection, in all healthcare settings. This is extremely dangerous for patient safety.”
HB 4637 does nothing to increase PA's scope of practice. PAs currently practice at a scope determined at the practice level based on their training, education, and experience. This scope is determined through the same privileging process used with physicians for PAs in hospitals and other practices.
PAs in Illinois already prescribe and administer all drugs, including Schedule II narcotic drugs by injection. In fact, these privileges are allowed under current legislation without physician delegated authority in hospitals and other hospital-affiliated settings. Delegated prescriptive authority tied to collaborative agreements is unnecessary and outdated, reduces patient access to qualified high-quality care in underserved areas, and provides no mechanism to promote patient safety.
“This bill providing for independent practice of physician assistants WILL NOT INCREASE access to care. While non-physicians often promise that scope expansions will increase access to care, especially in rural areas, the evidence shows this is a failed promise. For example, even in states that have allowed independent practice, nurse practitioners have not moved into the rural areas.”
This is not true. Evidence from Harvard Medical School and the BMJ published in the 2023 shows that increased care by non-physician providers (NPPs) such as PAs complements the care provided by physicians. This study showed that NPPs did not replace physicians but instead saw an increased number of lower acuity patients, while physicians continued to see more complex patients, increasing the number of patients overall who had access to care.
The number of patients seen by NPPs (both PAs and NPs) has continued to increase in the last decade, including in rural areas. However, there continues to be a critical shortage of providers in Illinois.
“This bill would make Illinois an outlier. These bills present a considerable change from the current regulation and practice of physician assistants and would make Illinois an outlier compared to other states. The majority of states have requirements that are much stricter than Illinois, such as requiring physician supervision.”
Under HB 4637, Illinois would lead in expanding access to care for its residents by modernizing PA practice. Right now, Illinois is an outlier of a different sort, leading the nation with one of the largest shortages of health care providers. Working together, we can change that.
“Physician assistants are trained to work as part of a team with physicians. They are not trained to independently practice as physicians do. The Physician Assistant Education Association (PAEA) has previously criticized attempts to remove legal supervision and collaboration requirements fearing this could lead to the negative consequences of compromising physician assistants’ success and confidence and posing a potential risk to patient safety.”
The Physician Assistant Education Association (PAEA) currently supports Optimal Team Practice, and has since May 2017 (citation: https://paeaonline.org/our-work/current-issues/otp).
The PAEA has also written a letter (link) in support of our current legislation.
“The Illinois State Medical Society has negotiated in good faith with Illinois Physician Assistant Association for the last decade and has agreed to reasonable changes in their practice act.”
This is not true. The ISMS has refused to discuss updates to the PA Practice Act with the Illinois Academy of PAs and has stonewalled efforts for conversations with other stakeholders.
“Just last year, we made additional changes to how physician assistants are regulated in federally qualified health care centers and provided for a period of transition if a collaborating physician suddenly is not able to practice.”
While we appreciate ISMS not opposing the changes passed in 2023, the medical society did not make these additional changes to the PA Practice Act. These updates were passed by efforts of the Illinois Academy of PAs to expand access to care in FQHCs and rural areas of the state where physician recruitment remains challenging.
“While physician assistants are essential in a patient’s care and treatment, there is no substitute for having collaboration with a physician who has a far more training and education. Not only will it be confusing to patients who may not understand the differences, allowing PAs to practice independent of physicians will likely lead to increases in misdiagnoses and over-utilization of services. For these reasons, we respectfully urge you to vote NO on HB 4637.”
We continue to unequivocally support team-based care and collaboration with physicians. However, the preponderance of recent evidence does not support that optimal PA practice leads to "misdiagnoses and over-utilization of services." These kinds of statements are not evidence-based and do nothing to improve access to care for Illinois patients.