Title Talk

Physician associate title change: AAPA CEO discusses the switch

Q&A with Lisa Gables aims to clarify the rationale behind the decision and explain AAPA’s stance on team-based care.

Editor’s note: On May 24, the American Academy of PAs (physician assistants) passed a resolution affirming “physician associate” as the official title for the PA profession. The vote followed several hours of deliberation by AAPAs House of Delegates (HOD) members and several years of study by an international marketing and communications firm, according to the AAPA announcement.
The AOA issued a Position Statement on May 28 in opposition, saying that, “The American Osteopathic Association calls for truth in advertising, intellectual honesty and transparency with the use of professional designations of non-physician clinicians in service of the public interest. We also call for organized, collaborative discussions among stakeholder organizations in the Physician, Advanced Practice Registered Nurse and Physician Assistant communities to find common ground on these important topics.”
The AOA leadership initiated conversations with the AAPA to better understand the AAPA’s rationale for this change. The DO recently interviewed the AAPA’s Chief Executive Officer and asked her to explain the Academy’s intent, strategy of implementation and impact on patient care. Here’s the Q and A with AAPA CEO Lisa Gables.  The responses provided are representative of the AAPA’s positions, but are not intended to imply the AOA’s agreement with or endorsement of those statements.

What prompted the decision to change the PA title to physician associate?

Title change has been the subject of discussion within the PA profession for many years. There has been long-standing concern about the disconnect between the PA profession’s brand identity – which includes title – and the role of PAs in day-to-day medical practice . . . that the title does not adequately reflect their role and responsibilities in delivering quality healthcare to patients.

The decision by AAPA’s HOD to change the PA title was the result of a methodical process that unfolded over the course of three years and was informed by rigorous and substantial research by independent experts.

At the root of these discussions was the fact that the title ‘physician assistant’ does not accurately describe to patients what the profession does, nor does it convey the value of PAs within the healthcare team and healthcare delivery system.

In response to a 2018 HOD resolution, AAPA hired an independent international marketing, communication and research firm – WPP – to conduct a comprehensive investigation into the title change. Foley & Lardner LLP was also engaged in the research regarding legal, regulatory, and legislative impact of a title change.”

What did the research about the PA title reveal?

“In May 2019, WPP presented results from qualitative research of PAs, PA students, patients, physicians, employers and others, that indicated the title “physician assistant” was not seen as a good fit with a PA’s role and responsibilities.

Another quantitative WPP survey of PAs and PA students also found that 90% of respondents cited a disconnect between their official title – physician assistant – and their role in healthcare. More than 100 potential titles were reviewed and evaluated. The list was ultimately refined down to a short list, after legal and management review.

Regarding the physician associate title, according to Kantar Research:

  • 71% of the 432 patients surveyed agreed that the title ‘physician associate’ matches the job description of a PA.
  • 65% of 132 physicians surveyed agreed that ‘physician associate’ matches the job description.

In November 2020, AAPA’s House of Delegates was presented with the final, comprehensive report from WPP, as well as reports from AAPA’s legal counsel. The presentation was robust and rigorous, filled with data to be digested and applied as delegates returned to their respective constituencies to prepare for the May 2021 House of Delegates Meeting. In May 2021, AAPA’s House of Delegates spent several hours debating and discussing a title change. Ultimately, the HOD passed a resolution by majority vote affirming ‘physician associate’ as the official title of the PA profession.”

Was the vote among AAPA members overwhelming in favor of the title change?

“In May, the AAPA House of Delegates passed a resolution affirming a title change to physician associate by a majority vote of 198 to 68.”

Is the title change mandatory across the board, or do certain states have the right to accept or reject the decision by the national organization?

“Each state chapter and specialty organization will make its own determination about pursuing the title change. We believe it is important for the profession to have a unified title, however, as well as a unified voice. For that reason, we will be working with each state chapter to help them move forward with the change when they are ready.

Changing our professional title will require legislative updates at the state and federal level and we believe this process could take years.”

A few medical societies, including the AOA, spoke out publicly against the name change and warned that it puts patients at risk. What’s the AAPA’s response to them?

“As healthcare providers, we share a common mission to serve patients. This is what unites us. We are committed to collaborating with medical societies and other groups to ensure that our ultimate goal – caring for patients – remains our top priority.

A title change is one way to further help clarify the role of PAs, and it will give patients a better understanding of the essential care PAs provide them. Moving forward, as we pursue legislation to enact the title change at the state and federal levels, we will collaborate with allies who share our common goal to continue to provide patients with high-quality, team-based care.”

What’s the AAPA’s stance on the physician-led, team-based model? Does the title change have any impact on that?

“PAs are committed to patient-centered, team-based medical practice with physicians and other healthcare providers. The goal of title change is to provide PAs with a title that better reflects their role and, in particular, provides greater clarity for patients about the part PAs play as a member of their healthcare team – resulting in a better patient experience.

According to Kantar Research: 71% of patients surveyed agreed that the title ‘physician associate’ matches the job description of a PA.

Data shows that PAs face much confusion about their role in the healthcare system: In a recent survey, 75% of patients chose the wrong definition of “physician assistant.” The selection the patients made did not align the profession to the actual roles and responsibilities of PAs.

Updating our professional title will better reflect what PAs already do – not change what PAs do.

PAs already have their own panels of patients, develop and manage their treatment plans and prescribe medications. PAs often practice with a high degree of autonomy in many practice settings. Title change will not impact practice. During the transition from the title ‘physician assistant’ to ‘physician associate,’ PAs will continue to collaborate with, consult with, and refer patients to other healthcare providers as needed – just as they do now.”

Is the AAPA is pursuing practice changes?

“Yes. PA laws are extremely outdated and need to be updated for the modern healthcare environment. As we saw during COVID-19, outdated practice models kept PAs from being able to fully serve their communities.”

In their statements following the AAPA announcement, many medical societies fear that the name change will create confusion and lack of transparency with patients and even the idea that non-physicians will present themselves as doctors. Do you anticipate any confusion that might create patient safety issues, and what’s the AAPA’s stance on transparency in patient care?

“What we know to be true, based on research, is that the title physician assistant is what actually confuses patients. Too often, there is a misconception that PAs are only able to “assist” physicians – and this lack of understanding can create a barrier between the PA and their patient.

PAs are proud of their profession and their role on healthcare teams. They WANT patients to understand what a PA does and how they work WITH physicians and other members of a healthcare team. PAs will continue to collaborate with, consult with, and refer patients to other healthcare providers whenever the patient’s condition falls outside of their education, training, and experience. The PA profession’s commitment to team practice is powerful.

Changing the name of the profession will not affect how PAs provide care to patients. Patient safety is of utmost importance to PAs and their healthcare teams. A shift in title to ‘physician associate’ will provide greater clarity for patients about PAs’ role in their care but will not change how healthcare is delivered to patients.

This title change does not change the role PAs play in team-based care nor does it indicate that PAs wish to change their role in the future.

Transparency in patient care is of the utmost importance, and we believe that starts with patients understanding the education, training, and experience of all of their healthcare providers.”

What does the AAPA hope will be the long-term outcome from this title change?

“All healthcare providers, including PAs, share one primary goal: to provide safe, effective, high-quality care to patients.

Similarly, AAPA’s primary goal is to ensure that every PA is practicing to the full extent of their education and experience. I think we can all agree we need more people in healthcare who can provide high-quality care to as many patients as possible.

Updating the PA title won’t change what PAs do. It will provide more clarity regarding the role of PAs on the healthcare team, increasing the efficiency of team-based care. We know patients will continue to value the healthcare provided by PAs. Additionally, updating the PA title and recasting the PA brand will aid employers and policymakers as they seek to understand the roles and responsibilities of each member of the healthcare team to improve the efficiency and effectiveness of our healthcare system.

Removing the word ‘assistant’ from the title will eliminate a common misconception that PAs only ‘assist’ physicians, when in fact they diagnose, treat, and care for patients. The new title and brand will help patients to better understand PAs’ education, training, and expertise and their role in healthcare delivery.”

Related reading:

AOA statement on physician-led care, physician assistant title change and non-physician clinician use of the title ‘doctor’

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