Next HAPA board/membership meeting is scheduled for 6:00 pm, Wednesday, January 16, 2008 at Sam Snead's.   Your HAPA Board of Directors: David Messer III, PA-C,  President; Rocco Laudadio, Jr., PA-C, Immediate Past President; LeeAnn Clark, PA-C, Secretary; Jodi Virata, PA-C, Treasurer, Members at Large: Fielding Mercer, PA-C,  Susan Rinaldi-Weldon, PA-C

NEWS BRIEFS

An editorial by Dr. Norman Goldstein, a prominent doctor who supervises a physician assistant, was published by the Hawaii Medical Association, calling upon the HMA to extend membership to non-physician providers including PAs.  Perhaps it's time for us to join forces and cement a relationship with our docs, and win over new ones... Let us know what you think. 

Will there be a shortage of qualified medically trained providers in Hawaii's future?

Physician Assistant Practice In Hawaii

Because of pharmacy statutes passed last year, there is a new Hawaii NED requirement that charts of patients for whom PAs have ordered controlled substances be reviewed and initialed by the supervising physician.

Due to these recent legislative amendments, the Administrative rules (H.A.R.) are being reviewed by the Board of Medical Examiners (BOME).  The BOME is considering amending the rules which regulate Physician Assistant Practice in Hawaii. Two anticipated areas for change include the chart review process and the number of PAs a physician may supervise. Local PA leadership, through the Hawaii Academy of Physician Assistants, (HAPA), has surveyed physicians who supervise PAs, developed propsals for specific language based on the survey results and made recommendations to the BOME for these changes.

A bit of background information: The current Hawaii rule states that the supervising physician will personally review records for each patient within seven working days. This review, which typically is carried out by physician co-signature, is a time consuming and burdensome process for busy physicians. Early physician assistant statutes were written without the benefit of experience with PA practice. American health care now has nearly 40 years of experience with physician-PA teams. The early state laws requiring that all PA-written chart entries be signed by physicians were drafted to assure ongoing physician oversight. But like many aspects of clinical medicine, the best patient care decisions are made not as blanket requirements in law, but rather as a customized response to individual practice situations.
Rigid co-signature requirements in state law can actually diminish the opportunity for quality physician oversight. If, for example, a physician is required to counter-sign all routine orders, the doctor has less time available for in-depth discussion of specific cases with the physician assistant, or for review of practice guidelines or systems for care.
Laws and regulations governing physician-PA teams should be updated periodically to reflect experience with PA practice and evolutions in health care systems. While preservation of supervisory and oversight function is critical, requiring supervising physicians to co-sign every PA-written order or chart removes the doctors’ discretion to exercise supervision in the way that works best for their practices. It can also place an unnecessary burden on the doctor, detracting from the efficiency of care the physician-PA team delivers.

Current Hawaii law that states a supervising MD may supervise up to 2 PAs concurrently. Many states have increased the number of PAs a supervising physician may supervise. HAPA has proposed that the number be increased to 3, with the option for more under specific circumstances with BOME approval.

The BOME recently developed its own proposal for the chart review process which involves a two-tiered system with greater monitoring requirements for new PAs and/or new supervising physicians. 

The BOME also declined to revise the number of PAs a superivsing physician may supervise concurrently (two).

Continued input from Hawaii PAs and their supervising physicians is needed as this process goes on.

PAAC

To be successful, any lobbying for PA rules changes probably a) need to be sponsored by a physician, and b) have full support of the PAAC (Physician Assistant Advisory Committee) and HAPA.  Time to get involved.. HAPA and PAAC are willing to be your voice.  Specific rules changes involve increasing the number of PA's a doc can supervise at any one time and relaxing the chart review rules. 

Vince Tenorio, PA-C is chairman of the Physician Assistant Advisory Committee to the Board of Medical Examiners. Other members: Honey Marquez, PA-C, Laura Reifsteck, PA-C, Robert Frankel, PA-C, and Leonard Duvall, PA-C.

The BOME has asked the PAAC to investigate a means to monitor impaired PA providers, and we are seeking ways to mirror what the Hawaii Medical Association does for docs... see related story... Dan Domizio, Representative Green and others have indicated an interest in proposing rules revisions to the BOME through HAPA.  HAPA has established a committee to investigate and make recommendation, chaired by Robert Frankel.   Please contact Rob if you'd like to volunteer time or have suggestions. 

TIME TO RENEW

Annual membership value! $50 for PAs and $10 for Students! Request your application from our membership coordinator: Rhiarose Magbitang, PA-C.   Don't be late!  All memberships expire December 31, regardlesss of when the membership was submitted.

Help Needed with PA Student Rotations

We are currently receiving a very large number of requests and Vince can't handle them all, so if there are any other PA's who are willing to serve as preceptors for students in any or all specialties please let us know. Leave a message on e-mail or contact Vince Tenorio.

NCCPA News Read more here.

Letters to the Editor: We have no current letters.
Editor's note: Please post your comments and replies here.  All opinions may be truncated or edited for space or grammatical issues.

AAPA

For the latest from our national office, click here.  This include a link to get info or register for the AAPA national conference each May. 

Committee News

Conference Committee
If interested in helping plan the next conference and other CME opportunities throughout the year, please email Bob Null or call 668-4864 (H).  The 20th Anual Aloha Medical Conference is scheduled for October 2008 at the Sheraton Waikiki.  See you there...

Membership Committee
Membership Dues: Membership is for calendar year only.  All memberships automatically expire on 12/31. Rhiarose Magbitang is our membership coordinator. The membership list is officially updated and published on Jan. 31. Late memberships are always welcome, but there is no proration.

Newsletter Committee

Mike Tagaki is the newsletter editor and publisher.  If you'd like to contribute information, a story, or editorial commentary or criticism to The Hawaiian Times, please contact Mike.   If you prefer a hard copy of this newsletter, which is slightly different than what you see here, please let us know.

Physician Assistant Advisory Committee / BOME    
This year the PAAC will be closely monitoring the various legislative committees to make sure none slip under the radar as far as regulatory implications.  We are also involved in the PA Hawaii Census Project. When we discover legislation that affects the physician assistant community this information is shared first with the BOME then reported to the groups affected as efficiently as possible.   The executive secretary of the BOME has requested in writing that PAAC volunteers no longer contact BOME members outside of official business meetings to lobby for policy or rulemaking changes.               

The Physician Assistant advisory Committee is here to represent you to the Board of Medical Examiners. Should you have questions of a regulatory or enforcement nature contact us:     Vince Tenorio PA-C Secretary, Family Practice;  Honey Marquez PA-C General Surgery, Robert Frankel PA-C, Surgery; Laura Reifsteck PA-C, Neuro Surgery; Leonard Duvall PA-C, Family Practice.

CME

Dec. 31, 2007 - NCCPA Final deadline to earn and log CME and pay all fees for the 2005-2007 CME cycle.

UCSF Sponsored Conferences
Browse the UC San Francisco CME page for more information for the following courses, then Register online:Medical World Conferences       Browse the website for a complete listing then register by email:

Plastic Surgery Research Foundation     (800) 228-9290, (858) 587-1414   

Alaska CME -
AKAPA's upcoming Summer CME - Contact Becky Strachan AKAPA - Executive Secretary (907) 455-4649 / (800) 478-8684 www.akapa.org

Free Stuff
collection of free online medical texts
http://www.freebooks4doctors.com/
Journal service: http://www.amedeo.com