AAPA President and Chair Discusses Importance of PAs in Dermatology

"I hear a lot about PAs or NPs taking people's jobs or taking physicians' jobs. Not with 100 million people without access to care," said Jennifer Orozco, DMSc, PA-C, DFAAPA, president and chair of the American Academy of Physician Associates (AAPA). "No matter which route people go down, PAs are here, and they're here to stay, and they can really help improve the lives of dermatology patients."

Orozco recently spoke with Dermatology Times® to discuss the role of AAPA in advocating for PAs in clinical settings, including in dermatology.

Jennifer Orozco, DMSc, PA-C, DFAAPA: My name is Jennifer Orozco. I am the president and chair of the Board of Directors of the American Academy of Physician Associates (AAPA). I have been a practicing PA for over 20 years now, mainly in vascular surgery, has been the bulk of my clinical career, but I'm also a former director of advanced practice providers, where I was responsible for 400 PAs and APRNs at a large academic medical center in Chicago. I am now working as a principal and a consultant for Health Management Associates in their delivery system design team and really helping with innovation, and models of care, and delivery system redesign for physicians, PAs, NPS, and hospital systems to think about how they can do it differently.

Dermatology Times: What is the AAPA and how does it assist PAs across the country?

Orozco: So AAPA, we're the national professional organization for PAs. We represent more than 168,000 PAs in this country and PA students nationwide. So our main role is really, which is our mission and our vision, is PAs transforming health through patient-centered, team-based medical practice. We lead the profession, and really are about empowering our members to advance not only their careers, but really patient health. And we do a lot of focus on advocacy, communication, as well as research and education. We have a we have a swath of activities for PAs, so anybody from who's brand new to the profession, as well as people like me and others who have been in the profession for some time, that really support our states, and what our states do, our advocacy, how they're changing laws and rules and regulations to not only optimize PA practice, but really to improve health for all patients, and improve access to care for all patients. So we do a lot of work nationally, and are really, truly the spokesperson for PAs at the national level.

Dermatology Times: Are there any current legislative topics being discussed to improve advocacy for PAs?

Orozco: Well, right now, we have our priorities in our states. The legislative efforts are really to create what we're calling 'optimal practice environments,' and the main crux of that is removing the administrative or the legal tether constraints that a PA can deliver. Many states still require what's called 'supervising physicians,' and that's an antiquated term we actually don't even use anymore, because we collaborate with everyone in medicine. And many states have moved towards more holistic language around collaborating physicians. And in fact, what we've seen is 6 states already have removed the requirement for PAs to be legally tied to a physician in Arizona, Iowa, Montana, North Dakota, Utah, and Wyoming. And many of these states, they did it for good reason, and it should apply to all states. These are outdated barriers, they have no evidence in practice whatsoever. They're not patient protective; it has nothing to do with patient safety. This is something that's been in place since the 1960s and 70s, when medicine was very different, and sometimes our laws and our regulations don't keep up the way that they should. And I think in the states that I mentioned, you can hear many of them are rural, and patients that are suffering. They can't get physicians to go, there's not enough physicians in this country, there won't be for some time, and there's just not enough for every patient. Right now, there are almost 100 million people without access to primary care, and 157 million without access to mental health care. And I think we just heard the Surgeon General, if I'm not mistaken, this past weekend, talking about mental health in youth and how important it is. And we just don't have enough. PAs are here and can do all of those things. And so we have to figure out, whether it's primary care or whether it's dermatology: How do we deliver that care, and improve patient lives, and really focus on prevention rather than just treatment of patients when they're sick?

Dermatology Times: How do dermatology PAs improve patient care in a clinic or practice?

Orozco: Bottom line is, PAs improve access to care in every setting, every specialty, when they're allowed to practice to the fullest extent of their training education experience, and I can tell you as someone who's gone for through PA school, and over many years with continuing education, we have one of the most rigorous medical training programs out there. Some of the findings that we have is wait times for dermatology appointments are getting longer. A report found that wait times for dermatology increased almost 46%, from 2009 to 2019. And this is because in derm, we know that many people again, focusing on that prevention, want to get into someone who is an expert, and can treat them, and look at them, and help them work on prevention. And so similar to those 100 million Americans without access to primary care, we have staffing shortages. We have this perfect storm post-pandemic. We have staffing shortages, whether that's PAs, whether that's a respiratory therapist, whether that's a nurse, we're really short staffed, and PAs are part of that modern solution to help us in health care. I'll tell you as a PA who works in vascular surgery, it's very, very specialized, and so people say often, 'What do you mean, you work in vascular surgery?' I said, 'Well, yeah, for 20 years.' And similar to dermatology, we do a lot of procedures. I'm in the operating room. I see my own set of patients, there's follow ups. We have to remove that administrative burden, the inefficiencies, in medicine. We don't have the luxury of seeing providers either multiple times, seeing both physicians, and PAs, and NPS, and that is wasteful in in health care. And patients want to get in, and patients need to get in. If patients have cancer or some other type of dermatologic emergency, and to say that you have to wait 4 to 6 weeks is really unacceptable in a country like ours. And so PAs are really starting to to be the solution for patients; they have the expertise, they have the training, and they do in dermatology, I had the benefit of going to the Society of Dermatology PAs conference in the last year, which was packed. And these PAs are doing amazing things. Dermatology, you couldn't pay me enough. I think it takes special people to work in different specialties. Just as I couldn't work in cancer care, vascular and blood vessels works for me. There's a PA for that in every specialty and setting. I hear a lot, and I'll just be frank, I hear a lot about PAs or NPs taking people's jobs or taking physicians' jobs. Not with 100 million people without access to care. They're just not; it's not a true statement. That's meant to drive fear and to get people riled up. Part of what we focus on at the academy is about what's best for patients. So all the rest is noise. We provide safe, competent care in every specialty, it's proven, and those are the facts. So no matter which route people go down, PAs are here, and they're here to stay, and they can really help improve the lives of dermatology patients, and help with anything from prevention, to life-saving treatment. And that's what we're here to support, and we're going to continue to do so in each one of the states.

Dermatology Times: How do you hope to see PAs and physicians working together in the future?

Orozco: I have a lot of physicians that I work closely with at my own medical center, and I had said I had been responsible for 400. I work closely with physicians now, and I think physicians get it. We're all tired. We're all tired; the burden's on all of us: the administrative burdens from EHR, and documentation, and all of the other things that come along. I have tremendous respect. PAs are not trying to be physicians. We're not trying to take over things. We are committed to team-based practice, always have been. We collaborate with everyone, whether that's a physician, whether that's a nurse, whether it's a physical therapist. We're trying to do what's best for patients. And I think when physicians can start to come together to say, 'Hey, this is about what's best for patients,' that at the end of the day, that's what it's about. It's not about money. It's not about who's in charge. We have to strip that all away. Medicine is very old school and hierarchical, and we have to have this shift. And I think the pandemic showed us that shift. We had nobody. So we all collectively came together and said, 'All right, we all have these great skills.' And that was my job when I worked during the pandemic, was provider redeployment, and so I sat in the room with all the physicians, and the executives, and the PAs, and the NPS, and the nurses, and we said, 'How are we going to do this?' And we built teams, and we spread people out, because we know that they have the skill set. You don't only have the skill set during a worldwide pandemic. So let's use it, because 100 million people without access to primary care is just unacceptable, and people are suffering. So let's help patients not suffer anymore, and I think there's a lot of physicians who really, really want to do that, including in dermatology.

[Transcript edited for clarity]