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Legislative Q & A

Written by Leslie Milteer, PA-C, MPAS, DFAAPA

MAPA Legislative Committee Co-Chair


Why do we need to make changes to the MN PA practice laws when we have such a great practice environment already?  

Over the last 3-5 years with changes in NP practice and the changes related to fewer and fewer independent physician owned practices, the specific attachment of one PA to one physician has created a negative employment environment for PAs in the job market. In addition, the ongoing liability that a physician must assume to work with a PA is no longer desired and many physicians are declining to take on that responsibility.  

The current environment of health care delivery requires more flexible teams, and each member of the team needs to be able to work to the highest level of their education and experience. Current practice regulations do not allow PAs to practice to their full capacity due to the restrictions of the “single physician delegation of our practice scope”.  

Due to these factors, and many more nuances of the changing healthcare environment, MAPA is working to remove restrictive regulations that only serve to complicate and limit PA practice rather than protect patient safety.  We have volumes of data that prove PAs provide high quality, cost effective care and that having a PA in any practice setting increases access. Despite these facts, and our current strong regulatory laws, PAs are being overlooked, overly restricted and losing parity of practice, by no fault of their own - as a result of legislative changes for other professions.  

Since NPs have independent practice, when will we be going for that?

We are not seeking independent practice. Team based care delivery has always been, and continues to be, the foundation of how we want to practice medicine as PAs.  

Numerous studies have proven team-based care is optimal for patients, as well as providers, by encouraging high quality accessible, cost effective care that respects all members of the team and creates fluid utilization of all team member’s skills and training. This is why the AAPA created the Optimal Team Practice policy. Optimal Team Practice occurs when PAs, physicians, and other medical professionals work together to provide quality care without burdensome administrative constraints.  

MAPA is working diligently to remove the burdensome paperwork that currently creates confusion and obstructions for PA practice. The current process of the delegation agreement and supervised practice within the constraints of a single physician does not create safety for patients, but rather creates burdensome paperwork, most often retrospective oversight and limits to care access. In addition, the current paperwork has the potential to create retrospective punishment for the PA and supervising physician due to clerical errors even if no care delivery wrong doing is identified.  

MAPA has a bill prepared for introduction that will remove the burdensome administrative paperwork by removing the delegation agreement and supervisory mandates that restrict the ability to be full participating members of healthcare teams.  


What is MAPA doing to level the playing field with the NPs?

Let’s be clear, we do not fault our NP colleagues in any measure for their legislative successes.  We all work side by side in the clinical setting and want to continue strong practice level relationships for the benefit of quality patient care.  

MAPA is aware that there has been some significant backlash since 2015 due to the NPs achieving independent practice. This includes changes in hiring patterns moving away from PA hiring in preference of the less administratively burdensome regulatory practice of NPs, as well as the increasing reluctance of physicians to sign the supervisory practice agreement due to potential liability connected to PA practice.  

MAPA is actively reaching out to all health systems in MN to educate them about PA practice; as it currently is and how it could be modernized to better serve patients. The legislative agenda, combined with continued outreach to PA leaders and administration in the major health systems, is intended to highlight and clarify how PAs can best be utilized and expand access to care.  

PAs need to recognize when their practice is being unnecessarily restricted due to misunderstandings of the paperwork or lack of awareness of changes that have occurred. As an example: There has never been a statutory requirement for chart co-signature and the requirement for a signature signifying review of prescriptive practice was removed in 2001. The 1:2 physician PA ratio was increased to 1:5 in 2009 and totally eliminated in 2016.  

PAs should reach out to MAPA when they are not sure or if something at the practice level seems “off”. MAPA is a resource as well as a mentor that can educate and empower PAs to better advocate for themselves and the profession as a whole – but MAPA doesn’t know you need help if you don’t stay connected and reach out, and you may not know you have a problem if you aren’t staying aware of the changes in the marketplace and the regulations. We are stronger when we work collectively as a professional academy. MAPA is here to help you and you can support that work in so many small ways – just being a member helps with the work.  


I've read about OTP on the AAPA website. Is MAPA going to create an independent PA Board?

No. MAPA has diligently worked to create a respectful and open flow of communication with the Minnesota Board of Medical Practice. The BMP is very respectful of the PA Advisory Counsel and takes their recommendations into strong consideration regarding matters of PA practice.  

MAPA asserts that we do indeed practice medicine and therefore should be a part of the Board of Medical Practice.  In addition, being under the jurisdiction of the BMP as a regulatory body means that PAs will continue to be regulated by physicians – which strengthens our argument that the excessive supervisory paperwork is redundant and unnecessary.  


Why do you need me to come to St Paul to meet with my legislator?  You guys know the issues - can't you just do it? 

Legislators want to hear from the people in their district – not from organizational leaders who have no influence on their re-election. Legislators only believe something is important if their constituents tell them it is and why. While most are cordial with professional associations, they are much more likely to change their views or get behind supporting something if they understand that it is good for the people in their district. We know that constituent visits have the greatest impact on legislator’s decisions.


Additionally, your entire MAPA leadership team is composed of volunteer PAs who also have jobs and families themselves. They do what they can to the best of their abilities and at the sacrifice of their personal time. More PAs are needed to take just a little time to help advocate for the recognition and progress of the profession. Professional advocacy needs to be just as important as completing CME credits, because no one is going to look out for the PA profession besides PAs. Progress is made faster when many people participate in the work.      


I'd like to participate at PA Day on the Hill, but I don't feel like I know enough to talk with a legislator without looking silly. 

The only thing you really need to be comfortable talking about is why you love being a PA and the impact you have in your role. Beyond that MAPA will arrange all the appointments and provide all the talking points and handouts needed for legislative visits. We are confident that any PA can navigate this empowering event with ease and confidence.  

Keep in mind the legislators are elected by us – they are essentially our employees – there is no need to be intimidated by these visits – you are speaking to a community member about why PAs are great and why they should support PA positive legislation.  Most visits last about 15 minutes – some longer if the legislator is engaging and able to spend more time.  

In person visits serve as a reminder that when the legislator is reviewing any healthcare legislation, they should consider how PAs could enhance the delivery of care. Very rarely does anyone go to a legislative visit alone – unless they want to. MAPA, as always, has your back and will prepare you for the visit.  

I live too far away to drive to St Paul for Day on the Hill, and besides, I can't get the time off anyway.  Is there another way I can participate in the effort?

ABSOLUTELY!  MAPA can help facilitate an at home district meeting with your legislator, provide email templates to reach out to your legislator – and work administration – or arrange a visit on another date in Saint Paul if you have any plans to be in the area in the future. Just let us know you’re willing to reach out to your legislator and tell us what your availability may be.  

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