Doximity: Hi Dave, thank you for speaking with me today and congratulations on a successful conference and for being elected president of AAPA. Can you please tell me about your current role and work?

David Mittman: Thank you. I have had a non-traditional PA career working for over three decades in medical communications. I am currently editor-in-chief of Clinician 1, a web community for PAs and NPs. Before that I worked as a Family Practice PA. As the President of AAPA, I will serve as the face of the profession, represent the academy and membership, visit state chapters, and meet with other medical, NP, and government groups.

Dox: How long have you been on the AAPA Board of Directors? What is the board's goals?

DM: I have been on the Board of Directors for four years. I was also on the board 30 years ago and have since come back with more business and life experience. The board’s goals are to set the organization’s strategic direction, maintain the organization’s financial health, and advocate for the profession. The board works to ensure AAPA’s vision is realized, which is promoting physician assistants as instrumental in transforming health care through patient-centered, team-based medical practice.

Dox: Great, AAPA clearly does a tremendous amount on behalf of PAs and the profession. What were your highlights from this year's conference?

DM: Our people. I truly believe we have the most wonderful dynamic profession in the world. It was great to stop and meet fellow PAs who are excited about our collective future. There was a great session called “Yes I Scan” where students spent the day learning point-of-care ultrasound skills.

We at AAPA have also been working with branding and public relations experts to look into a potential title change for the profession and that was discussed extensively at the conference. It is the first time we are formally examining the title and asking experts - does it represent what we do? This is one issue that the House of Delegates also discussed among other policy issues for the profession.

Dox: What do you think are the most pressing issues right now for PAs?

DM: Optimal Team Practice (OTP) is a top priority for AAPA and for me as president. OTP is a way to modernize PA practice. Much of our legislation was written in the 1970s when PAs were an experiment in health care. 51 years later PAs have over 400 million patient interactions every year  in the U.S., and are practicing globally. Barriers that were written back then are holding us back now. There have been so many changes in the way health care is delivered and laws and regulations need to modernize. “Full responsibility” is another important phrase in OTP. PAs need to be responsible for what they do and it should be PAs governing our own profession.

Another important issue is advocating for direct payment for physician assistants. PAs are the only health profession authorized to bill Medicare, but unable to receive reimbursement directly. This restriction can limit PA employability with staffing companies and certain group medical practices.There is currently direct pay legislation pending in Congress and we are hopeful we can see some movement on this bill this year.  

We’re also working for improved transparency for PAs and patients. For example, in certain situations under Medicare, PAs have to bill their services under the name of the physician. Medicare can’t tell what percentage of care is delivered by PAs versus doctors. We believe it’s very important for patients and the public to know who is doing what.

Another personal goal of mine is to see more PAs involved in telemedicine and virtual health. Personally, I believe telemedicine is one of the main ways health care will be delivered in the future and PAs need to be better informed. Much of telemedicine will be delivered across state lines and will affect legislation. This past year, AAPA created a new special interest group, PAs in Virtual Medicine and Telemedicine. Questions to consider: what are the barriers and roadblocks? What’s telemedicine’s role in PA training and education?

There is also a shortage of mental health clinicians all over the country. PAs are needed to provide mental health care services especially in the current opioid crisis, but it hasn’t been an area PAs usually practice in. States determine who can provide mental health care services. There are different certifications for it - social workers, nurses, etc. and it has taken a while for PAs to see their role in mental health care.

Dox: Why should PAs get involved with AAPA?

DM: AAPA has a pretty robust membership. AAPA and state organizations provide an insurance policy that every PA needs to keep our profession strong, adaptable, and patient-centered. They watch out for every PA working in every state and setting. As one would not drive a car without insurance, in the same vein, we need our national organization to provide those 24/7 protections to ensure we do what we do best - take care of patients. AAPA is very much an advocacy organization.

AAPA also provides many professional benefits for PAs: CME products, a live, on demand, learning central, and OTP resources for states to begin the process. AAPA also posts news stories and publications. Our site also has plenty of career resources on job opportunities, salary information, an online community called The Huddle, and much more.

This interview was conducted by Angelica Recierdo, Op-Med Editor