House of Delegates Meeting New Orleans 2018 (AAPA annual conference)

If anyone is interested, I made a summary of everything that occurred at the HOD Meeting this year. The most heated debate were B14, B15, and C14 if you want to get right to the "good stuff". If anyone would like this in a word document, please let me know your email. 

HOD 5/19/18-5/21/18 
Resolution 1150: Mr Katz extracted, motion fails, remains 
Resolution 2615: Mr Katz extracted, motion fails, remains 

Extracted from A: 1, 2, 6, 7, 13, 22: 
A2: Did not want to get rid of the striked out portion. “Adherence to the AAPA Guidelines for Ethical Conduct for the PA Profession (Policy Paper 15 – page 179), AAPA’s Articles of Incorporation, these Bylaws, and AAPA’s rules and policies, and generally acting in a manner that is consistent with AAPA’s purposes MISSION, is a condition of membership.” 
-Recommend adopt 

A6: 1. Wants addendum: wants to avoid a special counsel to vote if someone on the board resigns, try to save costs. 2. Con: wants a vote. 
-Recommend amend: Extracted by accident, carries as amended by reference committee. 

A7: Wants to know if this is going to narrow the pool, author states they are casting a wider net, larger pool. Wants to know if the student organization are included-there is one student that qualifies (trustee on the PA Foundation) 
-Recommend amend 

A13: Get rid of wants of family. It reads as families’ wishes are more important than patients’-wants change in language. Lots of small wording changes 
-Recommend amend: Extracted. Change supervising to collaborating (which has to be done individually in each resolution. Also recommend removing laundry list of seeking guidance from numerous individuals. Others state there are important people to seek guidance from and others that may not be appropriate (i.e. Janitor) . Carries as amended by reference committee 

A22: Change PA expert to PA serving as an expert witness 
-Recommend amend 



Extracted from B 1, 2, 3, 4, 5, 6, 9, 11, 14, 15, 16, 18: 
B1: Wants to keep Physician extender. 
-Recommend amend: Extracted. Add “allied health professionals” to discouraged terms, motion passed 

B2: Language change 
-Recommend amend: Extracted. Concern that APP was in B1, but was already voted to be removed. APP is used for billing, does not think that we need to group ourselves into this term (con). MI delegate con, feels this is limiting this to other advanced clinicians, cause problems with collegiality. Floor amendment want to remove “refer only to” and “change to appropriate terminology to use to describe collective work of PAs and APRNSs in a healthcare of system or practice”. Recommended amendment 

B3: strike out physician assistant, just use PA. PA is also abbreviation for other professionals, such as pharmacy assistants 
-Recommend adopt 

B4: language change, medical to professional (line 8) 
-Recommend adopt 

B5: language change to multidisciplinary to interprofessional (line 9) 
-Recommend amend 

B6: VA concerned that if you get rid of NCCPA certification due to if not certified at the VA, you are immediately fired. 
-Recommend refer 

B9: Change medical to professional 
-Recommend adopt 

B11: language change 
-Recommend amend 

B14: Over a million dollars to potentially change the name, concerned with the costs. The board (spoken by Gail Curtis) is pro. It is a title change, not a name change. Virgin Islands rep wants to know if cost per state/territory has been investigated. The word assistant implies needing supervision and working towards OTP. To get support from physicians, a change is needed. Concern from Missouri is that they spent a lot of money with PR recently explaining Physician Assistant. Feels like it would have all been a waste of money. This is just for investigation, this money is not for implementation cost, hopefully that would be part of the information gained in the investigation. This investigation may not be completed by 2019, all that is required is a report. MAPA changed mind from con to pro due to the current discussion. Feels like the investigation will help speak for the MI PAs who don’t feel like their voice is being heard. 
-Recommend adopt: Extracted. Add specific areas to investigate, motion carries. 

B15: Concern that it states in collaboration with physician. Many practice autonomously a majority of the time. Concern that without clarification this may be misinterpreted as independent practice. Board (Gail Curtis) speaks con and clarifies that this is not independent practice. Lines 38-39 would undermine OTP. KY concerned that she cannot write controlled substances and in lobbying there were concerns that PAs were trying to be independent. She feels that this resolution will help reassure the physician groups. Educator worried that without this resolution will lose placement spots for students from physicians not wanting to take PA students. Other thinks that we are just masking wanting independent practice and calling it OTP. OTP is owning our own profession, not practicing alone. Does not want to own his own practice but does want to be able to sign without needing cosignatures. Change line 38-39 to try to appease colleagues. 
-Recommend reject: Extracted. Motion to reconsider fails, resolution rejected. Motion to reconsider was denied. (close vote) 

B16: Change opiate to opioid, author: we have to have 24 hour training whereas physicians only need 8 hour training, working towards making it equal, also agree with the change 
-Recommend amend: Extracted. Resolution amended. 

B18 (late resolution): Feels the number of 80% is arbitrary, difficult to move families, need the distance/online training. ARC-PA speaks con, no matter the teaching method, schools have to be accredited. They want to see the data that students who go through predominate online studies are less prepared. Yale has the highest online training. Yale program director available and described their mixed based learning, con to proposal. Technology is the future of medicine, you can do BLS online. You can see providers online via Skype-type modalities. This would make it more difficult for disadvantaged/rural/low socioeconomic status students. A 2011 graduate from Yale stated that there were a group of students that went to the Dean to oppose the online program. The cost of the school is the same, college is just making more money (although cost of living would be cheaper than having to move). Prior Yale director (before change in their program) is concerned that those with more online training have worse communication skills, less empathetic. “Not able to read the room” 
-Recommend reject: Extracted. Propose complete change of resolution to “The AAPA House of Delegates recommends the four major stakeholders of our profession AAPA, PAE, ARC-PA and NCCPA set up a joint meeting to jointly evaluate the need of determining a degree of required face to face education to evaluate the impact of PA programs with a majority of their didactic instruction on-line on the PA profession and report back to the 2019 house.” Gail Curtis, president AAPA believes this is not in our jurisdiction. Also, concerned with cost. 
ARC-PA states this is far reaching. It is the ARC-PA’s job to evaluate this. ARC-PA does not distinguish types of learning. Resolution to be referred. Motion to reconsider has been denied. 




Extracted from C 1, 3, 4, 6, 8, 9, 13, 14, 16, 18: 

C1: Time for a change 
-Recommend amend by substitution 

C3: Change gender to sex 
-Recommend amend 

C4: Wants to have clarified definition of what a “qualified” program is. Residency programs are paying quite well and want to be competitive. Postgraduate programs can give a new grad more opportunities, may employers want experience. 
-Recommend adopt: Extracted. Want to change “qualified postgraduate” to “clinical postgraduate”. Con is that postgraduate includes didactic as well as clinical. Amended motion passes. 

C6: Change should to encourage (line 25) 
-Recommend adopt 

C8: Change gender to sex (line 10) 
-Recommend amend 

C9: Worried about far sweeping consumer order testing, as public health representative stated that whether he was consulted or not, wants to know about STI positive results. Pro-the genetic information provided can be held by the company for unknown purposes. Author doesn’t want to deny the test, just wants follow up care. 
-Recommend amend: Extracted. Author speaks pro to the amendment. Motion to refer to committee, fails. Further amendment to change to “have results and potential clinical implications interpreted in collaboration…” Motion carries and amended motion passes. 

C13: Wants to add PA program, add other minority institutions 
-Recommend amend 

C14: PAs are excluded from increased unsubsidized loans compared to other healthcare professionals (pro) Cap for medical students 40,500. Grad plus loans distribution fee 2.5-4% variable interest rate 6-9%. Concern that if loans are increased than schools will increase tuition. PA cap is $20,000 for unsubsidized loans. 
-Recommend adopt: Extracted. Wants to add the term “Stafford” loan limits. This would avoid raising the debt ceiling, which may cause schools to increase the cost of school. Congress is currently looking at prosper act which would change loans and this would be irrelevant. Amendment fails. Resolution is adopted. 
C16: Concern that we are supporting legislature that restrict the use of opioid containing medications in children. Wants us to keep control of how we practice medication. 
-Recommend reject: Extracted. Thinks this should be referred as there is some good information in the resolution but needs to have some changes. Motion to refer carries (by 3 votes) 

C18 (late resolution): No con testimony 
-Recommend adopt