Statement on Physician-Led Care and Physician Assistant Title Change and non-Physician Clinician use of the title "Doctor"

CHICAGO, May 28, 2021 /PRNewswire/ -- 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 American Osteopathic Association (AOA), which proudly represents its professional family of more than 151,000 osteopathic physicians (DOs) and medical students nationwide, is deeply concerned by the potential harm to patient care and patient safety resulting from the erosion of physician-led, team-based care. A physician-led team ensures that professionals with the highest level and most extensive degree of medical education and training are adequately involved in clinical decisions and patient care. "Physician-led" does not imply "physician optional."

The AOA, and the physicians whom we serve, value the important contributions made to our healthcare system by our non-physician colleagues. Advanced Practice Registered Nurses (APRNs), Physician Assistants (PAs), and others have worked tirelessly with physicians to care for patients prior to and throughout the COVID-19 pandemic, often under suboptimal and emergency conditions that put their own health and safety at risk. Their selfless service is to be commended. However, it is important to recognize that there is no substitute for the unique and extensive education and training that provides the foundation for physician-level medical decision making.

Non-physician clinicians, including APRNs and PAs, are an integral part of physician-led healthcare teams. Healthy discussions and collaboration, regarding safe and appropriate skill set substitution, roles and responsibilities are in order, and we welcome them.  However, recent rhetoric has limited this important discussion to claimed territory and optical positioning through the use of professional titles, such as "Doctor" in a clinical setting by non-physicians and "Physician Associate" without consultation with the physician community.  Further, we recognize the struggle of achieving professional parity (i.e. scope of practice, prescribing and compensation) between APRNs and PAs. However, efforts to seek parity among non-physician clinicians must not be at the expense of the truth in advertising and clarity of roles in our healthcare system.

There are important differences between the education and training requirements for physicians and non-physician clinicians. Physicians across the United States, osteopathic (DO) and allopathic (MD) alike, must meet the same education, postgraduate training and testing requirements and practice in supervised environments that afford progressively greater autonomy before ultimately becoming eligible to treat patients on their own through licensure competency assessment and rigorous board certification standards. These requirements ensure that all patients are treated safely and with the same standard of care.

DOs complete four years of medical school, which is comprised of two years of didactic study and two years of clinical rotations, followed by 12,000 to 16,000 hours of supervised graduate medical education (i.e. "residency") before becoming eligible to independently diagnose and treat patients.

The American Academy of PAs (AAPA) has begun a push towards autonomy for PAs, first through their "Optimal Team Practice" model which was adopted in 2017 and advocates for the total elimination of any legal or regulatory requirements that PAs must maintain a relationship with a physician¹, and now through their recent vote to change the PA name to "Physician Associate¹." According to their press release, the name change followed several years of study by an international marketing and communications firm. Professional credentials, titles and how we convey such information to patients is of great import and not a matter of marketing. This title change could easily create confusion for patients and put their safety at risk. Likewise, there are nurse anesthetists who seek to use the title "nurse anesthesiologist," and other nurses with academic doctorates in nursing philosophy who use the title "Doctor" in a clinical setting, allowing patients to conflate their doctorates with the rigors of physician-level education and training. Many states have truth in advertising laws in place to protect against these situations and help ensure that patients know that important medical decisions are being guided by physicians.^{2, 3, 4} 

We strongly believe that all patients deserve access to high-quality medical care provided by a fully trained and licensed physician. The House of Medicine needs to collectively support the practice of medicine and work to ensure physician leadership for patient care. We are calling on our peers in the healthcare community to join together with policymakers to support policies that recognize the importance of the physician-led medical team model, ensuring that physicians, the only professionals with comprehensive medical education and training, are appropriately distinguished from non-physicians and are adequately involved in the care of this nation's sick and injured.

About the American Osteopathic Association
The American Osteopathic Association (AOA) represents more than 151,000 osteopathic physicians (DOs) and osteopathic medical students; promotes public health; encourages, funds and disseminates scientific research; serves as the primary certifying body for DOs; and is the accrediting agency for osteopathic medical schools. To learn more about DOs and the osteopathic philosophy of medicine, visit www.osteopathic.org.

¹ See https://www.aapa.org/wp-content/uploads/2019/03/Infographic_Optimal_Team_Practice_Letter_Size_FINAL_020819.pdf
¹ See https://www.aapa.org/news-central/2021/05/aapa-house-of-delegates-votes-to-change-profession-title-to-physician-associate/
² See https://www.einnews.com/pr_news/533916837/njaops-supports-the-health-care-transparency-act-signed-by-governor-murphy
³ See https://codes.findlaw.com/ca/business-and-professions-code/bpc-sect-2278.html
⁴ See https://www.courts.state.nh.us/supreme/finalorders/2021/20190716.pdf

SOURCE American Osteopathic Association

Related Links

https://osteopathic.org