The American College of Clinicians is Born
National Coalition Founded to Unite PAs and NPs

Timothy Herrick, Clinician News, 7(9):1, 10-11, 2003

San Antonio, Tex-This year, a core group of NPs and PAs, all with leadership
credentials, decided that the time was ripe to create a national PA/NP
organization with an innovative agenda. Known as the American College of
Clinicians (ACC), this organization considers its paramount mission to unite
and promote nurse practitioners and physician assistants as partners in the
health care system. A first-of-its-kind national organization, the ACC was
founded by, and is dedicated to serving, both professions-PAs and NPs.

The ACC's statement announcing its formation identifies a compelling need to
establish a formal alliance between NPs and PAs. "Unlike physicians, NPs and
PAs lack a national political organization that advocates the rights of all
advanced practice clinicians.... We recognize that the time has come for PAs
and NPs to have a group that represents interests that are common to both
groups," the statement says.

A Long-Brewing Concept
According to David Mittman, PA, Senior Vice President, Clinicians Group, and
Communications Director of the ACC, this newly formed national association
is an outgrowth of discussions NPs and PAs have been having for years about
how the professions could work together and combine their influence to
achieve results desirable to both professions.

As Mittman and other ACC members explain it, the idea of coordinating policy
and promotional initiatives between the two professions has been a constant
topic of conversation between PAs and NPs who met in informal settings at
health care conferences and similar events.

"I have spoken many times to groups of NPs and groups of PAs on the
similarities and differences of our professions. In every instance-over what
is now a 12-year period-someone brought up the concept of starting an
organization to forward both professions," says Mittman.

"There are many NPs and PAs who have come to realize that by not working
together, we will impede our future evolution as clinicians," adds Mittman.
"We realize we are separate professions and that we will not agree on
everything, but we will agree on much. Working together, we can help each
other and come to understand each other."

PAs and NPs joining together in a formalized organization is not a new idea.
Besides working side by side in every conceivable practice setting for
decades, and precepting students from each other's profession, there has
been a growing grassroots movement of regional NP/PA groups, some going back
almost 30 years (see Regional NP/PA Grassroots Alliances Proliferating, page
24).

Although the ACC will be the first national NP/PA coalition, its genesis is
the same as that of the grassroots organizations-a recognition that PA/NP
training, expertise, and methods of delivering care are very close to each
other. "The fact is that as clinicians, NPs and PAs are on the same roof-we
just climbed different ladders," says Ken DeBarth, RPA-C, of Ocracoke, North
Carolina, and an ACC Advisory Board member. "We have a lot more issues in
common than we have issues that are different."

The ACC intends to build upon the long-standing workplace collegiality
between PAs and NPs by transforming it into a nationwide alliance that can
educate other professionals about advanced practice clinicians and advocate
the professions. NPs and PAs have accomplished similar scopes of practice in
most states and fill identical clinical roles in patient advocacy, patient
education, preventive medicine, and primary care. On the other edge of this
sword are misconceptions about both PAs and NPs held by physicians,
pharmaceutical executives, managed care administrators, legislators, and the
general public. Increasingly, these misconceptions are being translated into
practice barriers for both NPs and PAs.

Why Come Together?
"I'm very excited about being part of the ACC," says Roger Green, ARNP,
President of the Florida Nurse Practitioner Network. "Let's face it: Neither
PAs nor NPs have done a great job in promoting ourselves. By joining forces
on some issues, we have nothing to lose and everything to gain."

Many feel that combining the groups will create clout unattainable by
separate organizations. "By bringing together both professions, our numbers
can reach a critical mass and we can promote changes beneficial to both NPs
and PAs and to our patients," says William H. Fenn, PA-C, PhD, Professor,
Physician Assistant Department, Western Michigan University, Kalamazoo.

Fenn does not see the ACC as an alternative or competitive organization to
the American Academy of Physician Assistants, or to the American Academy of
Nurse Practitioners or the American College of Nurse Practitioners. Instead,
he sees the ACC as "a complementary organization, a bridge organization for
the two professions. It is a logical evolution for both NPs and PAs to
acknowledge that we have only few or minor differences, and many, many
things in common."

Tom Yackeren, PA, a past president of the New York State Society of
Physician Assistants and founding partner of Clinicians Publishing Group,
says that one advantage of the organization is "when ACC members meet
educators and policymakers, we will not be seen as a 'self-promoting'
organization as is sometimes the case." He adds, "To me, the ACC is also
about removing practice barriers to provide better patient care."

According to Michael Champion, PA-C, Executive Director of the ACC, "It is
time for an organization representing both professions to work toward
achieving the shared goals of NPs and PAs."

Gerry Keenan, PA-C, MMS, President of Partners in Practice-Physician
Extender Consulting Service, eagerly joined the ACC Advisory Board because
the organization reflects the reality of the workplace. "We have very
similar training, and in the workplace, we are being used interchangeably.
To not work together at this point in the evolution of both professions is
simply not an effective use of resources," he says.

NPACE President and Chief Executive Officer Mimi Secor, MS, FNP, who is also
a founding ACC Advisory Board member, recalls how a few years ago the Nurse
Practitioner Associates for Continuing Education began inviting PAs to its
conferences. Secor soon saw the sense of a more unified effort. "PAs and NPs
have the same educational needs, and the same challenges in terms of
networking, health policy, insurance reimbursement-a host of issues," says
Secor. "An umbrella organization that can coordinate efforts will enhance
all of us."

Overcoming Our Obstacles
ACC Advisory Board members feel the formation of the College is a first step
toward erasing misconceptions, as well as mutual practice restrictions,
because it begins to break down the artificial barriers that separate NPs
and PAs, hindering their cooperation on issues ranging from health care
policy to reimbursement.

"There's a long-standing animus between PAs and NPs, and that needs to be
eliminated," explains Marie-Eileen Onieal, PNP, Health Policy Coordinator,
Bureau of Health Quality Management, Massachusetts Department of Health, and
a founder and former president of the American Academy of Nurse
Practitioners.

"PAs and NPs have made changes-in prescriptive authority, Medicare
reimbursement, admitting and clinical privileges-and I don't think
accomplishing any of them has been easy. But we've been kind of pitted
against each other by the system, because we are competing against some
physicians, and we are looking for more formidable, substantive changes to
follow through on issues such as reimbursement. NPs and PAs working together
can have strong and loud voices," says Onieal.

San Antonio, Texas PA Blaine P. Car michael cites a need to overcome
pervasive misconceptions. "I think there has been one arm of PAs and NPs
that, whe ther intentionally or not, have done a 'divide and conquer' by
emphasizing unimportant distinctions between the two professions," says
Carmichael, who is Immediate Past President of the Association of Family
Practice Physician Assistants.

"At the same time," Carmichael adds, "there are some physician groups, and
some isolated physicians in the medical and the popular press, that have
attacked both groups and spread misconceptions about our abilities and our
motives. But there's another arm, and I believe a bigger constituency, of
NPs and PAs who understand that if we unite, there's strength in numbers.
The ACC will be a unified voice from what used to be disparate voices."

Melody A. French, PhD, PA, FNP, Doyle Family Practice, Doyle, California,
cites lack of physician awareness about the role of PAs and NPs as a major
obstacle to both professions. Her experiences have shown that the more
physicians use NPs and PAs, the more their opposition to PAs and NPs
decreases. "It's surprising how many physicians still have misconceptions
about NPs and PAs, and that feeds the opposition by organized medicine,"
says French.

Getting Started
Currently, the ACC consists of a 30-member Advisory Board, comprised of
well-known, highly regarded, and widely respected NP and PA leaders,
including educators, high-profile clinicians, and current and former
officeholders of state and national PA and NP organizations. As the flagship
charter membership drive unfurls nationwide and initial dues are
collected-priced at a nominal $45-Advisory Board members are in active
communication with each other to develop an organizational structure and
future programs.

The ACC is being officially announced in featured advertisements in
Clinician News, Clinician Reviews, and later, in other publications read by
NPs and PAs.

The first ACC "gathering" will be held during the National Advanced Practice
Conference in Orlando, Florida, April 14-17, 2004. (This conference is being
organized by NPACE [www.npace.org]; PAs and other advanced practice
clinicians are welcome to attend.)

Initial goals of the ACC include educating other professions and the general
public about PAs and NPs, and working on broader recognition issues with
managed care and the pharmaceutical industry.

Within six months, the ACC will launch an educational campaign that targets
physicians. Information-based advertisements explaining the capabilities of
NPs and PAs and how their utilization benefits practices and patients will
appear in leading physician-read magazines, including Women's Health in
Primary Care, Neurology Reviews, Pulmonary Reviews, Women's Health
Gynecology Edition, and Respiratory Reviews. (Combined circulation of these
journals exceeds 220,000 doctors.)

By early next year, the ACC also is planning a similar educational campaign
to appear in pharmacist- read publications. PA/ NP prescriptive authority
may be the rule in the vast majority of states, but the names of these
clinicians often do not appear on the prescription label, and some
pharmacists still refuse prescriptions legally written by a nonphysician.
This lack of recognition by those professionals filling a prescription makes
PAs and NPs invisible and can jeopardize the care of their patients.

"Most of the time, pharmacists are scared of reimbursement problems or just
don't know the law," says Mittman. "It's a problem that is widespread, and
it is a common issue that affects both NPs and PAs, and one that, if we work
on it together, the ACC can help alleviate."

Future Ambitions
These flagship programs accompanying the debut of the ACC are anticipated as
merely a start. Once the organizational structure of the ACC is in place,
membership grows, and its inaugural programs achieve positive results,
Advisory Board members foresee the organization growing and evolving in
innovative ways.

One service of the ACC (albeit one that is still under discussion) might be
that, upon request, representatives from the ACC will meet with state and
national PA and NP leaders and use conflict resolution techniques to find
common ground and create effective alliances to support legislative,
regulatory, and policy initiatives.

The need for these alliances is obvious. "NPs and PAs shouldn't oppose each
other, because right now, there are groups ranging from organized medicine
to insurance providers who are opposed to both NPs and PAs," says ACC
Executive Director Champion. "That opposition has an easier time being
successful because the PAs and NPs haven't joined together. NPs and PAs can,
through the ACC, provide a more unified front and work on legislation
together."

Beyond scope-of-practice measures, Champion asserts that the real benefit
for rank-and-file PAs and NPs is reimbursement. "At the state level,
reimbursement barriers are often an issue of insurance regulation, so to get
reimbursement from private insurers and from the 'blues' [Blue Cross/Blue
Shield], it's not an issue of practice act legislation. If NPs and PAs
combine their efforts, they can better approach the regulators, as well as
the insurance companies. We may not work independently on this; we may
facilitate PA and NP groups working together."

Says Onieal, "NPs and PAs have a substantial work force that is part of the
solution for the myriad problems in the delivery of health care, yet we are
both invisible in that system." She adds, "We share several barriers to
practice, from little things like not being listed in directories as primary
care providers, to outright reimbursement discrimination by managed care.
The state and national organizations representing PAs and NPs have had
little success on these issues, and one reason is that they don't represent
the numbers that a combined NP and PA organization, like the ACC, can."

"NPs and PAs both need and want autonomy and independent billing," says
Roger Jones, EdD, Director of Clinical Education, Bethel College PA Program,
McKenzie, Tennessee. "We've sort of shot ourselves in the foot by not
joining forces before, because a lot of the legislation in place is too
restrictive and doesn't encourage reimbursement from private insurance. But
together, NPs and PAs can bring a level of mutual support that neither
profession has had, to enable those changes."

Timothy Herrick, Contributing Writer