A PA Practice Act for Mississippi

Until April 2000, Mississippi remained the only state that did not license Physician Assistants (PAs). Efforts to pass a PA Practice Act were begun during the 1970s but the handful of PAs practicing without a formal law met strong resistance from organized nursing and some less vocal resistance from organized medicine. Practice acts were drafted and defeated (sometimes without ever being introduced) off and on during the 1980s. The fact that there was no law led to a paucity of jobs. In turn this led to a small number of PAs, which made it difficult to run a state association capable of pursuing a legislative campaign.

A Few Steps Forward

In 1994 the American Academy of Physician Assistants (AAPA) and the Mississippi Academy of Physician Assistants (MAPA) began to work together to plan a legislative campaign. The plan included opening a dialog with the Mississippi State Board of Medical Licensure (MSBML), the Mississippi State Medical Association (MSMA), and the Mississippi Nurses Association (MNA). In December 1994, MAPA and AAPA representatives met with MSBML, MSMA, and MNA representatives. Meetings with the MSBML resulted in the drafting of a bill that was approved by the medical board. Communications with the medical society resulted in the withdrawal of their opposition and the publishing of an article entitled "Physician Assistants in Mississippi' as the lead article in the December 1994 edition of the Journal of the Mississippi State Medical Association. In late 1994 representatives from MAPA and AAPA met with the MNA Board of Directors. The PA representatives made a formal presentation on PA education and practice and answered questions for over an hour. At the end of the meeting the Mississippi nurses vowed to reevaluate their previous policy (the MNA had a 1985 position paper opposing PA practice) and to keep the lines of communication open. At a meeting in early January 1995, the MNA decided to remain neutral on PA legislation in the 1995 legislative session.

A Step Back

Then on January 30 of that year, MNA opposition resurfaced. According to MNA leadership, this change was a reaction to proposed rules (which were separate from the PA bill) drafted by the MSBML, which, if adopted as drafted, would have imposed new restrictions on physicians who worked in a collaborative role with Nurse Practitioners (NPs). In a letter to the chair of the Mississippi House of Representatives Public Health and Welfare Committee, the MNA stated, "Until recent issues have been settled and there is some assurance that nurse practitioners will not be squeezed out of the health care picture, we find it impossible not to oppose a bill that will give physicians complete control over one provider while enacting rules and regulations that will greatly inhibit the practice of another." As a direct result of the MNA's letter, the bill was not scheduled to be heard in committee, which effectively killed the bill in the 1995 session.

MAPA and AAPA Settle in for the Long Road Ahead

MAPA and AAPA, again acting in concert, began to prepare for the 1996 session. A lobbyist who had previously worked for the medical society was added to the team and efforts to gather additional support began. By the start of the 1996 session the list of supporters had grown. The bill had the full support of the Mississippi State Medical Association, the Mississippi Academy of Family Physicians, the Mississippi Primary Care Association, and the Mississippi State Board of Medical Licensure. The bill was authored by State Representative Jim Barnett (a physician) and State Representative Reta Holden (a nurse). The MNA was contacted repeatedly prior to the legislative session but no communication from the nurses was received. At the start of the session the MNA conveyed their 1996 plan - they would once again oppose PA licensure. A hearing on the PA bill was held at the Mississippi state capitol in late January 1996. Ten PAs, the MAPA lobbyist, and a representative from the Primary Care Association were present to support the bill. A physician representing the medical society gave a very compelling testimony in favor of the legislation. Once again, the only opposition came from nursing. The MNA opposition focused on three points. First, there were many NPs in training in Mississippi. The nurses presented a map of where NPs practiced, and the numbers of NPs in training. They contended that NPs were or would fill all of the unmet health care needs in the Magnolia State. Second, the nurses discussed the fact that PAs would be solely regulated by the MSBML and that physicians would be able to delegate a wide variety of tasks to PAs. The physician representing the MSBML responded by saying that the medical board had taken a very conservative path when regulating physicians, and could be expected to do the same with PAs. The third concern was that licensing PAs would lead to the necessity for a PA program, which could compete for NP training funds. There was no current plan for a PA program in Mississippi. Unfortunately, the MNA opposition again led to the bill dying in subcommittee.

Mississippi PAs and Supporters Begin Plans for the 1997 Session

In late 1996, MAPA again invited the MNA to come to the table to discuss any concerns they might have with the PA legislation and in mid-December, representatives from MAPA, AAPA, and MNA met in Jackson to discuss the legislation. Following the meeting and discussions involving nursing leadership and NPs in the state, the MNA submitted a list of five proposed changes to the PA bill. The MAPA/AAPA negotiating team made numerous counterproposals and all but one issue was resolved. The MNA refused to negotiate on its demand that PAs must hold a master's degree in order to be licensed in Mississippi. In a memo to the MAPA lobbyist, the MNA stated, "The nursing community strongly supports that a provider who will be practicing in the same arena, should hold to these same standards." The Mississippi PAs decided not to add a requirement for a master's degree, but suggested compromise language that would leave it up to the state medical licensing board to determine the educational requirements for PAs. (The state nursing board dictates educational requirements for NPs.) This proposal was rejected by the MNA. With the start of the 1997 session, legislators were greeted with three bills that would regulate the practice of PAs in Mississippi. At a press conference held at the state capitol, reporters heard from PAs, physicians, clinic administrators, legislators, and a NP, all urging Mississippi to join her sister states and pass a PA licensing bill. The MNA was once again the only group in opposition to the bills. As in 1996, a hearing was held in a House subcommittee, and, just as in the previous year, no vote was taken on the PA legislation. The MNA opposition led to the bills once again dying in committee because the chair declined to call for a vote.

Good News Amidst the Bad

Even in the face of this defeat, support continued to grow. By the beginning of 1998, the list of supporters included The Southern Governors Association, The Mississippi State Medical Association, The Mississippi Academy of Family Physicians, The Mississippi Primary Health Care Association, The Mississippi Chapter of the American College of Emergency Physicians, The National Association of Rural Health Clinics, The National Association of Community Health Centers, The National Rural Health Association, and The Southern Regional Project on Infant Mortality. In addition, Governor Kirk Fordice declared October 6, 1997, Physician Assistant Day in MS. MAPA, AAPA, and hundreds of individual PAs and PA supporters throughout the country continued with educational efforts, networking, and media relations work in preparation for the 1998 legislative session. The immediate past president of the Mississippi Academy of Family Physicians presented compelling testimony in favor of PA licensure at a hearing of a Senate Health Subcommittee prior to the 1998 session. But once again in 1998 the PA legislation died in a subcommittee of the House Public Health and Welfare Committee. The bill's demise was due to opposition by the lone opposing group - the MNA. As he cast the first "no" vote, the Subcommittee Chair stated, "I believe that I wouldn't have any problem with either a nurse practitioner or a physician assistant treating me. But in the early 1990's we made a pact with nursing to increase training. Now the nurse practitioners are getting out and I believe we should allow them to get started. I am going to vote 'no' now. In the future I may change my vote."

Not in 1999, But Progress Continued

1999 was an election year in Mississippi. This meant legislators were generally unwilling to take up controversial legislation. Not surprisingly, the Public Health and Welfare Committees in both the House and the Senate refused to hold hearings on the PA licensure issue in the 1999 legislative session. When neither committee chair would hold a vote on the bill, it died in committee. Although no PA licensing bill was passed, the 1999 legislative session was a successful one on many fronts. There were three bills introduced for PA licensure - two in the House and one in the Senate. Twenty-seven legislators sponsored or co-sponsored the legislation. The co-sponsors represented a wide range of support: Democrats and Republicans, urban and rural legislators, and geographically diverse Senators and Representatives signed on to support the bill. Legislators were not the only ones supporting PAs. Support had grown throughout Mississippi and an increasing number of Mississippians understood the PA profession and wanted PAs added to the team of clinicians providing health care in their state. The issue received tremendous positive press coverage. A news conference held January 18 to announce the introduction of the legislation for the 1999 session was covered by three television stations, the Associated Press, and the Clarion-Ledger (the main Jackson, Mississippi newspaper). A Jackson television station ran a Saturday evening news report on PAs and the Biloxi, Mississippi newspaper ran a supportive editorial titled "It's time to unlock health care denied to Mississippians."

Not to be Deterred

MAPA President Murl Dotson was unwavering in his belief that a PA Practice Act would be passed soon. "We are concerned with the health of Mississippians, and we are persistent. We don't believe that PAs will solve all of Mississippi's health problems but if one additional child is immunized, if one more pregnant woman gets prenatal care, if one Mississippi native PA can move home to care for aging parents, even that will make things better," said Dotson. With these thoughts in mind, the PAs in Mississippi took advantage of the 1999 election year. A political action committee (PAC), the Mississippi Physician Assistant Political Action Committee, was formed. The purpose of the PAC was to increase the way in which PAs and their supporters were able to participate in the political process. In a show of support for PA licensing legislation in Mississippi, contributions from PAs and PA state chapters from across the country flowed into the PAC.

The New Millennium in Mississippi

The 2000 legislative session promised to be an interesting one. A second lobbyist was added to the team. As preparations for the session began, the Mississippi team again contacted the MNA. This time there was good news. The MNA was willing to sit down and talk. Once again the master's degree was the main point of contention. The MAPA negotiating team asked this question: Would the MNA consider language that would require a master's degree sometime in the future, but would allow licensure of PAs meeting standard requirements now? The MNA representatives agreed. Negotiation teams from the MNA and MAPA, with input from AAPAs Health Care Services Committee, began a series of meetings that culminated in an agreement on consensus language for PA licensing legislation. The MNA had withdrawn its long-held opposition. With an agreement on consensus language, the chairmen of the Public Health and Welfare Committees in both the House and the Senate offered to sponsor the legislation. "Allowing PAs to join the Mississippi health care team was MAPAs primary objective," said Dotson. "PAs are needed in Mississippi and it looks like soon we may be able to lend a hand."

2000 was the year!

Since April 2000, Mississippi PAs have enjoyed numerous clinical and professional opportunities as well as a strong practice foundation provided by the MSBML. Marc Finch, PA-C and Ann Davis have been instrumental in forging a positive relationship with our state medical board and paving the way for PAs to enjoy more beurocracy free practice. In recent years, MAPA, AAPA and our lobbyists have worked tirelessly to continue to improve the practice environment in Mississippi. Recent improvements seen by Mississippi PAs are the amendments made by the MSBML allowing PAs to prescribe controlled substances as well as the passage of the temporary licensure law. In 2007, legislation passed to include PAs among those healthcare providers who are granted civil immunity when providing emergency care, such as during the Hurricane Katrina aftermath. MAPA would like to thank everyone who participated in the hard-fought process to get PAs licensed in Mississippi. We are continuing to grow in numbers every year, and our efforts to expand the PA profession in Mississippi have been fruitful. With patience and persistence, not to mention continued excellence in health care, PAs will flourish here.