319 Physician Assistant Scope of Practice 2015
to go to battle for our patients. With my n=1 experience, I am proud to
say that this is worth fighting for. So, who is the leader in the patient centered medical home? The answer is easy: our patients. And they deserve
increased access to a team of providers. 309
The reality, however, is that the apportionment of medical services and
accountability within the PCMH model has been the root of substantial anxiety, often resulting in conflicting views among professional groups about
who is in charge and often losing sight of the patient entirely. 310 This stems
from the adamant insistence by organizations like the AMA and AAFP that
PCMHs conform to physician-led organized medicine. 311 Although these
and the other founding organizations of the PCMH concept assert that physicians should singularly lead the patient care, the organizations that offer
PCMH recognition or accreditation recognize PAs as primary care providers who are qualified to lead patient care teams. 312 The rationale is simple:
leading a PCMH and receiving clinical guidance from a physician are not
mutually exclusive concepts. 313 PAs routinely perform medical acts and
309. Bernstein, supra note 308.
310. Korda, supra note 307.
311. Letter from James L. Madara, MD, Executive Vice President, CEO, American
Medical Association to Mark R. Chassin, MD, FACP, MPP, MPH, President, The Joint
Commission (Apr. 12, 2013) (on file with the author) (“We support the proposed revisions
that would align the certification requirements with Stage 2 meaningful use criteria but remain concerned that the revised requirements do not fully recognize the critical role of physician (MD/DO) leadership/oversight of the medical home. We have the utmost confidence
in the ability of non-physician practitioners to safely perform specified patient care activities
under appropriate physician supervision, as occurs daily in many of our practices. However,
non-physician practitioners do not have the knowledge and experience to safely, consistently, and independently carry out the tasks demanded of the leaders of medical homes (“
primary care clinicians”), including, for example, directing patient care and reconciling medications for patients with complex pharmacological needs. We would note in particular that
non-physician practitioners such as advanced practice nurses and physician assistants are not
qualified to independently resolve conflicting recommendations for care, as is explicitly required of them under The Joint Commission’s glossary definition of primary care clinician.
It is for this reason that the ‘Joint Principles of the Patient-Centered Medical Home,’ which
were developed by the American Academy of Family Physicians, the American Academy of
Pediatrics, the American College of Physicians, and the American Osteopathic Association,
and endorsed by the AMA, assert that each patient should have ongoing relationship with a
personal physician (MD/DO) who should lead the medical home interdisciplinary team and
assume ultimate accountability for patient care.”); AM. ACAD. OF FAMILY PHYSICIANS,
PRIMARY CARE FOR THE 21ST CENTURY: ENSURING A QUALITY, PHYSICIAN-LED TEAM FOR
EVERY PATIENT 6 (2012) (“Leadership is required in a medical home just as it is required in
businesses, governments, schools, athletics, and other organizations. Just as every American
should have a primary care doctor, every medical home must have a physician serving as a
leader who brings the highest level of training and preparation to guide the integrated, multidisciplinary team.”).
312. ISSUE BRIEF, supra note 304.
313. AM. ACAD. OF PHYSICIAN ASSISTANTS, 2013-2014 POLICY MANUAl, 1, 75 (2013);
ISSUE BRIEF, supra note 304, at 3-4.