Mercedes Dodge grew up as the child of first-generation Peruvian immigrants in a modest home in a rural area of southeast Texas where there weren’t many health care providers, sometimes requiring them to drive to Houston, over an hour and a half away, for basic medical care.
Partly as a result of that experience, Dodge became a physician assistant. Since 2008, she has provided mental health and primary care to adults and children, many of whom come from communities like hers.
Dodge, who now lives in Austin, Texas, has built a steadfast patient base, including many from military families. But if any of them leave Texas, she will have to stop providing treatment, even via telemedicine, unless she gets a license to practice in that state.
“I’m doing my best and working with them, but they already feel alone,” Dodge told Stateline. “I ask myself, ‘Why can’t I be the glue? Why can’t I go beyond state lines and give them the care they deserve?'”
Medical assistantscommonly known as PAs, are licensed clinicians with a master’s degree and can practice in a range of specialties. Their three-year training typically includes 3,000 hours of direct patient care, and they are an increasingly critical part of the health care workforce that, in many states, is struggling to keep pace with a growing and aging population.
By 2028, the entire nation will be tiny about 100,000 vital healthcare workers – doctors, nurses and home care assistants – according to a recent report from Mercer, a management consulting firm.
The impending shortage is one of the reasons why 13 countries have joined the PA Licensing Compact, a multi-state agreement that allows PAs to practice in any participating state without obtaining an additional license.
Delaware, Utah and Wisconsin enact the legislation in 2023. Colorado, Minnesota, Nebraska, Oklahoma, Tennessee, Washington, Wisconsin, West Virginia and Virginia followed the example At the beginning of the year, Ohio became the last Stand to bring it into force in July.
The PA contract is one of several that have emerged in recent years, particularly since the expansion of telehealth services during the COVID-19 pandemic. There are Similar compact models for doctors, nurses, occupational therapists and Social worker.
One challenge has been conducting the required background checks for providers wishing to operate under the agreements. For example, Pennsylvania’s participation in the nurse and physician licensing agreements delayed when the FBI denied the state access to its fingerprint database. Later reached an agreement about what to do next.
The PA contract grants a “professional privilege” that allows PAs to practice in participating states without obtaining an additional license. The nursing contract gives nurses a several states License, while the physician license agreement only accelerated the licensing process.
I ask myself, “Why can’t I be the glue? Why can’t I go beyond national borders and give them the care they deserve?”
– Mercedes Dodge, medical assistant
Some gigantic states, such as California and New York, do not participate in agreements for doctors, nurses, social workers or nurse practitioners. Some lawmakers in these states believe that joining interstate agreements would lower the quality of health care workers in their states because other states require lower standards of education and training.
“We are proud that New York’s high standards have made our state an international healthcare destination,” said Deborah Glick, member of the Democratic Assembly of New York wrote in a comment last year for the Times Union newspaper in Albany. “While it’s possible that it might make sense for New York to join a licensing agreement at some point, we should pause before allowing a quick fix to lower standards in New York.”
In other states like TexasDoctors who have succeeded in limiting the “scope of practice” of Texas PAs oppose the contract because it would allow PAs from other states to exceed those limits for their patients living in Texas. The American Medical Association and its state partners argue that allowing PAs to perform procedures traditionally performed by physicians would put patients at risk.
Dr. G. Ray Callas, president of the Texas Medical Association, said he values the role of physician assistants in the health care system, but his organization opposes any measure that could “give physician assistants the authority to do more in the health care system than they are trained to do.”
“TMA is not opposed to appropriate, expedited approval, but we oppose these agreements when they expand the scope of practice and pose a risk to patient safety, thereby lowering the standard of care in Texas,” Callas said in a statement.
Last year, the Texas legislature considered legislation to join the PA agreement, but was rejected in the state Senate.
Monica Ward, president of the Texas Academy of Physician Assistants, said her group will continue to advocate for the bill.
“There is an absolute need and shortage of healthcare providers in rural areas of Texas,” Ward said. “We are surrounded by multiple states, so it’s nice to be able to reduce the administrative burden, paperwork and potentially fees for those who want to work in Texas.”
It will 18 to 24 months so that the Treaty can enter into full force and PAs can apply for authorization to practice in other areas. The Treaty Commission must also establish a data system to track licenses.
This licensing model might not have worked five years ago, said Tennessee Republican Rep. Jeremy Faison, who supported his state’s contract. legislation.
“There would have been a lot of resistance and people would have said, ‘What are you trying to accomplish with this? We like to control what we do in our state,'” Faison said. “But because we live in a global society and people are on the move so much more than ever before, I think the average citizen has embraced it.”
Faison told Stateline that for states like Tennessee, which border eight states, joining the agreement makes economic sense because it would encourage people to move to the state.
Financial stability was the motivation for 32-year-old Aneil Prasad to obtain a compact nursing license. Last year, he moved from New Orleans to Asheville, North Carolina.
“It allows people to get better-paying jobs and advance themselves, buy homes, have better health care and education and all that,” Prasad said. “And then the less competitive places are forced to raise their wages to attract people.”
After moving from Louisiana to North Carolina with his multi-state license, Prasad says his pay went from $21 to $36 an hour. He points out that while the multi-state nurse license costs a little more than a regular license, it would be much more costly for him to apply for a recent license in each state.
Because Texas has not joined the PA agreement, Dodge has valid licenses in her home state, as well as in Alaska, California, Florida, New Mexico and Washington. She said the process of obtaining them is costly and time-consuming. Licenses can cost as much as $500 and can take three to nine months to obtain. Dodge said it’s worth the effort to lend a hand her patients, but she would welcome an easier path.
“I have all these state licenses to care for my patients,” she said. “So when the PA Compact license goes into effect in Texas, I’m hoping that it will help me continue to care for my patients and that I will be the glue that they need.”
