<b>BUT TURNING NOW TO THE STATE'S</b> <b>HEALTH CARE WORKFORCE WHICH IS</b> <b>FACING CHALLENGES EVEN BEFORE</b> <b>THE ARRIVAL OF COVID-19, A</b> <b>SHORTAGE OF MEDICAL</b> <b>PROFESSIONALS DURING THE</b> <b>PANDEMIC LED THEN-GOVERNOR</b> <b>ANDREW CUOMO TO ISSUE AN</b> <b>EXECUTIVE ORDER GIVING PHYSICIAN</b> <b>ASSISTANTS AUTONOMY TO ACT</b> <b>WITHOUT TRADITIONALLY REQUIRED</b> <b>OVERSIGHT.</b> <b>AFTER OPERATING THIS FLEXIBILITY</b> <b>FOR A COUPLE OF YEARS, PAS ARE</b> <b>NOW LOOKING TO THE LEGISLATURE</b> <b>TO MAKE THIS EXPANDED POWER</b> <b>PERMANENT.</b> <b>FOR MORE ON THE ISSUE INCLUDING</b> <b>THE ROLE PAS PLAY IN THE HEALTH</b> <b>CARE SYSTEM, WE SPOKE WITH PATTI</b> <b>CUARTAS, A PA AND THE PRESIDENT</b> <b>OF NEW YORK STATE SOCIETY OF</b> <b>PHYSICIAN ASSISTANTS.</b> <b>>> PATTI, THANK YOU SO MUCH FOR</b> <b>BEING HERE.</b> <b>>> OH, THANK YOU FOR HAVING ME.</b> <b>>> SO THIS SITUATION IS KIND OF</b> <b>FROM BIRTH OF THE COVID</b> <b>PANDEMIC.</b> <b>I WANT TO TALK TO YOU ABOUT,</b> <b>FIRST, HOW WERE PAS OPERATING</b> <b>BEFORE THE PANDEMIC?</b> <b>THIS WAS A BIG CHANGE WHEN THE</b> <b>PANDEMIC STARTED.</b> <b>WHAT WAS IT LIKE BEFORE?</b> <b>>> WELL, PAS ARE TRAINED IN</b> <b>GENERAL MEDICAL MODEL.</b> <b>WE ARE ALL GENERALISTS.</b> <b>YOU KNOW, WE GO TO SCHOOL.</b> <b>WHEN WE GRADUATE, WE ARE</b> <b>LICENSED IN THE STATE OF NEW</b> <b>YORK TO PRACTICE EVERYWHERE AND</b> <b>SO WHEN WE THEN GET A JOB,</b> <b>THAT'S WHEN THERE'S A LOT OF</b> <b>ON-THE-JOB TRAINING.</b> <b>SO PAS CAN BE IN ORTHOPEDIC</b> <b>SURGERY.</b> <b>PAS CAN BE IN NEUROLOGY.</b> <b>PAS CAN BE IN DERMATOLOGY, THE</b> <b>EMERGENCY DEPARTMENT.</b> <b>AS A PA, YOU KNOW, WE HAVE A</b> <b>VERY BROAD SCOPE AND SO PAS WERE</b> <b>WORKING-- LIKE FOR ME, I WORKED</b> <b>IN THE EMERGENCY DEPARTMENT AND</b> <b>IN THE SURGICAL ICU AND IN</b> <b>ONCOLOGY.</b> <b>IT'S REALLY DEPENDENT ON</b> <b>ACTUALLY PAS PERSONALITIES.</b> <b>SOME PEOPLE ARE DRAWN TO ONE AND</b> <b>SOME PEOPLE LIKE TO DO DIFFERENT</b> <b>THINGS OR THEY'RE GOOD AT IT.</b> <b>THAT WAS BEFORE COVID.</b> <b>>> OKAY.

SO ONCE YOU GET TO THAT</b> <b>SCHOOLING AND YOU GO OUT INTO</b> <b>THE PROFESSION, LET'S TURN TO</b> <b>THE BILL WE'RE TALKING ABOUT.</b> <b>IT WAS BORNE FROM THE EXECUTIVE</b> <b>PANDEMIC.</b> <b>THERE'S THIS EXECUTIVE ORDER</b> <b>THAT ALLOWS PAS TO PRACTICE</b> <b>WITHOUT THE SUPERVISION OF A</b> <b>PHYSICIAN.</b> <b>THAT WAS ORIGINALLY DESIGNED</b> <b>BECAUSE THERE WAS SUCH A GREAT</b> <b>HEALTH CARE NEED DURING COVID.</b> <b>DO YOU STILL THAT HEALTH CARE</b> <b>NEED IN FACILITIES TODAY?</b> <b>>> EVEN WORSE.</b> <b>I THINK THAT COVID HIGHLIGHTED A</b> <b>LOT OF THE ISSUES WITH ACCESS.</b> <b>OBVIOUSLY, A LOT OF THE ACCESS</b> <b>AND THE NEED WAS IN THE CRITICAL</b> <b>CARE AREAS, RIGHT, IN THE</b> <b>EMERGENCY MEDICINE DEPARTMENTS</b> <b>AND IN THE, YOU KNOW, ICUS.</b> <b>>> SURE.</b> <b>>> BEFORE COVID, JUST TO BE</b> <b>CLEAR, THE PHYSICIAN SUPERVISION</b> <b>WAS ALWAYS-- NEVER ON-SITE.</b> <b>>> RIGHT.</b> <b>>> NEVER IN THE SAME PLACE.</b> <b>I WORKED, FOR EXAMPLE IN THE</b> <b>SURGICAL ICU AND I TEXTED MY,</b> <b>YOU KNOW, ATTENDING AT THE TIME</b> <b>OR THE ATTENDING OF THE DAY, AS</b> <b>LONG AS THERE WAS SOME</b> <b>COMMUNICATION.</b> <b>WHEN COVID OCCURRED, I THINK</b> <b>THAT EVERYONE REALIZED,</b> <b>INCLUDING THE GOVERNOR AT THE</b> <b>TIME THAT PAS WERE REALLY</b> <b>FLEXIBLE AND NIMBLE AND THE</b> <b>TRAINING ALLOWED TO BRING PAS</b> <b>THAT WERE NO LONGER DOING</b> <b>ORTHOPEDIC SURGERY BECAUSE THERE</b> <b>WAS NO ORTHOPEDIC SURGERIES</b> <b>HAPPENING.</b> <b>>> RIGHT.</b> <b>>> TO BRING THEM TO THE</b> <b>EMERGENCY DEPARTMENT WHERE THEY</b> <b>WERE NEEDED, AND WHAT DIDN'T</b> <b>ALLOW FOR THAT EASILY WAS THIS</b> <b>TETHERING OF ONE PA TO ONE</b> <b>PHYSICIAN.</b> <b>>> RIGHT.</b> <b>>> THAT'S WHERE THE EXECUTIVE</b> <b>ORDER CAME IN AND BASICALLY</b> <b>REMOVED THAT LEVEL OF</b> <b>SUPERVISION.</b> <b>AND THAT'S WHY IT WAS, YOU KNOW,</b> <b>IT REALLY ALLOWED THE PAS TO BE</b> <b>UTILIZED, REALLY, WHERE THEIR</b> <b>SKILLS WERE NEEDED THE MOST.</b> <b>>> SO THIS ENDS ON MAY 22ND.</b> <b>THIS WILL AIR AFTER THAT.</b> <b>WHAT DO YOU THINK THE</b> <b>CONSEQUENCES ARE OF THIS</b> <b>EXECUTIVE ORDER EXPIRING?</b> <b>LIKE, HOW DO WE SEE OUR HEALTH</b> <b>CARE SYSTEM SHIFT?</b> <b>>> SO, YOU KNOW, COVID</b> <b>HIGHLIGHTED ALL OF THAT.</b> <b>>> YEAH.</b> <b>>> THE EXECUTIVE ORDER HAS BEEN</b> <b>RENEWED EVERY MONTH SINCE MARCH</b> <b>OF 2020.</b> <b>>> RIGHT.</b> <b>>> HERE WE ARE MAY OF 2023.</b> <b>IT IS ONE OF OUR BIGGEST</b> <b>CONCERNS THAT, YOU KNOW, EVEN</b> <b>THOUGH COVID IS NO LONGER A</b> <b>PANDEMIC, THE PANDEMIC THAT DOES</b> <b>EXIST ARE THE DESERT AREAS.</b> <b>>> YES.</b> <b>>> YOU KNOW, WHERE RIGHT NOW,</b> <b>PAS ARE TAKING CARE OF PANELS OF</b> <b>PATIENTS AND THOSE PATIENTS MAY</b> <b>LOSE ACCESS TO THEIR PROVIDER</b> <b>WHEN THIS EXECUTIVE ORDER</b> <b>EXPIRES.</b> <b>>> I WANT TO CLARIFY THE BILL.</b> <b>BECAUSE THE BILL IS NOT SAYING</b> <b>THAT YOU GO TO PA SCHOOL.</b> <b>YOU GET OUT AND NOW YOU DON'T</b> <b>NEED PHYSICIAN SUPERVISION.</b> <b>THE BILL SAYS, IF THEY HAVE</b> <b>PRACTICED FOR MORE THAN 3,600</b> <b>HOURS.</b> <b>HOW LONG WOULD IT TAKE A PA TO</b> <b>GET THERE?</b> <b>I TIMED IT OUT.</b> <b>IT'S 450 8-HOUR WORKDAYS, 90</b> <b>WEEKS, BUT I'M ASSUMING IT'S NOT</b> <b>THAT SHORT BECAUSE YOU'RE NOT</b> <b>WORKING EVERY DAY.</b> <b>>> THAT'S RIGHT.</b> <b>IT'S ABOUT TWO YEARS.</b> <b>>> YEAH.

THE 3,600 HOURS REALLY</b> <b>IS FOR PARODY WITH WHAT THE</b> <b>NURSE PRACTITIONERS GOT LAST</b> <b>YEAR.</b> <b>AND YOU KNOW, BUT THE REALITY IS</b> <b>THAT NO ONE WORKS AND PRACTICES</b> <b>BY THEMSELVES.</b> <b>>> YEAH.</b> <b>>> WE ALL WORK IN CARE TEAMS,</b> <b>ALL OF US.</b> <b>YOU KNOW, WHAT WE REALLY WOULD</b> <b>LIKE THE BILL TO DO AND WHAT IT</b> <b>SAYS IT DOES IS IT JUST REMOVES</b> <b>THAT TETHER OF SUPERVISION.</b> <b>THAT'S IT.</b> <b>SO WE ARE NOT TETHERED TO ONE</b> <b>PHYSICIAN.</b> <b>BUT THE REALITY IS THAT WE ALL</b> <b>WORK IN TEAMS.</b> <b>IF YOU GO TO THE EMERGENCY</b> <b>DEPARTMENT, YOU SEE THAT THERE'S</b> <b>TEAMS OF PEOPLE, YOU KNOW, YOU</b> <b>NEVER SEE-- AND NOW THE-- THE</b> <b>INDEPENDENCE OF ONE SINGLE DOC</b> <b>OR ONE SINGLE PROVIDER IS NO</b> <b>LONGER THE CASE FOR A LOT OF</b> <b>REASONS.</b> <b>>> YEAH.

YOU KNOW, WHEN I'M</b> <b>THINKING ABOUT THIS ISSUE, I'M</b> <b>THINKING ABOUT TRIPS TO THE</b> <b>EMERGENCY ROOM THAT I'VE BEEN ON</b> <b>WHERE I SEE EXCLUSIVELY A PA</b> <b>WHO, YOU KNOW, WILL TELL ME</b> <b>WHAT'S WRONG WITH ME, GIVE ME</b> <b>SOME CARE HOPEFULLY, BUT WHAT I</b> <b>ALSO NOTICE IS THAT THERE ARE</b> <b>JUST NOT ENOUGH PEOPLE WORKING</b> <b>IN THESE HOSPITALS AND EMERGENCY</b> <b>ROOMS.</b> <b>DO YOU THINK THAT THIS CHANGE</b> <b>WOULD HELP THAT; ATTRACT MORE</b> <b>PEOPLE TO BEING A PA SO WE CAN</b> <b>FILL THESE GAPS?</b> <b>>> YES, ABSOLUTELY.</b> <b>RIGHT NOW, IT IS A BIT DIFFICULT</b> <b>TO GET INTO PA SCHOOL BUT THERE</b> <b>ARE 28 PROGRAMS IN THE STATE OF</b> <b>NEW YORK, OVER 250 PROGRAMS IN</b> <b>THE ENTIRETY OF THE UNITED</b> <b>STATES AND GROWING.</b> <b>BECAUSE THE PROFESSION IS</b> <b>GROWING.</b> <b>IT'S GROWN 74% JUST IN THE LAST</b> <b>10 YEARS.</b> <b>>> WOW.</b> <b>>> IT'S PROJECTED TO GROW 30%</b> <b>JUST IN THE NEXT 7 TO 10 YEARS</b> <b>AS WELL.</b> <b>SO YES.

ABSOLUTELY.</b> <b>THE PATIENT ACCESS, YOU KNOW,</b> <b>THE BARRIER TO ACCESS, WHETHER</b> <b>IT'S PATIENTS WITH MEDICAID OR</b> <b>COMMERCIAL INSURANCE REALLY IS</b> <b>GETTING TO SEE THAT PROVIDER.</b> <b>IT'S NOT EVEN ABOUT SPECIALISTS,</b> <b>IT'S THAT PROVIDER.</b> <b>>> I WANT TO END BY TALKING</b> <b>ABOUT THE TRAINING AND THE</b> <b>EXPERIENCE OF PAS.</b> <b>BECAUSE I IMAGINE SOME PEOPLE</b> <b>MAY THINK, WELL, I DON'T KNOW IF</b> <b>I WANT TO BE SEEN BY A PA VERSUS</b> <b>A PHYSICIAN.</b> <b>I WOULD LIKE YOU TO KIND OF</b> <b>QUALM THOSE FEARS.</b> <b>TELL ME WHAT GOES INTO THAT</b> <b>TRAINING?</b> <b>WHAT GOES INTO THAT CLINICAL</b> <b>TRAINING THAT QUALIFIES PAS TO</b> <b>DO THIS?</b> <b>>> SO THE TRAINING IS INCREDIBLY</b> <b>RIGOROUS.</b> <b>YOU KNOW, THE JOKE IS SAY BYE TO</b> <b>YOUR FAMILY AND YOUR FRIENDS</b> <b>ONCE YOU GO INTO PA SCHOOL</b> <b>BECAUSE IT IS 9:00 TO 5:00, JUST</b> <b>IN DIDACTIC FOR AN ENTIRE YEAR</b> <b>EVERY DAY.</b> <b>IT IS ENGRAINED IN ALL OF US</b> <b>BECAUSE OF OUR CURRICULUM, WHICH</b> <b>IS NATIONALLY CREDENTIALED ART</b> <b>PA.</b> <b>IT IS ENGRAINED THAT THE PATIENT</b> <b>IS FIRST.</b> <b>THE PATIENT IS THE CENTER OF</b> <b>EVERYTHING.</b> <b>BECAUSE OF THAT TRAINING, WE</b> <b>ALSO KNOW THAT, YOU KNOW, WE ARE</b> <b>GENERALISTS.</b> <b>SO WHEN THE PATIENT NEEDS MORE</b> <b>CARE, BECAUSE WE ARE IN A CARE</b> <b>TEAM AND THAT'S BEEN PART OF OUR</b> <b>TRAINING, WE ALWAYS GO TO WHERE</b> <b>THE PATIENT NEEDS CARE THE MOST.</b> <b>SO EVEN FOR MYSELF, I HAVE BEEN</b> <b>A PA FOR 23 YEARS.</b> <b>I WORKED IN THE EMERGENCY</b> <b>DEPARTMENT, AS I MENTIONED.</b> <b>I WORKED IN ICU.</b> <b>I WORKED IN ICU TAKING CARE OF</b> <b>INCREDIBLY CRITICAL PATIENTS BUT</b> <b>I WASN'T BY MYSELF.</b> <b>I ALWAYS WORK WITH THE NURSES,</b> <b>INCREDIBLE NURSES, AND SOME OF</b> <b>THE PHYSICIANS THAT WERE</b> <b>SPECIALISTS BUT THEY WEREN'T</b> <b>SITTING IN THE ICU WITH ME.</b> <b>YOU KNOW, WHATEVER THE PATIENT</b> <b>NEEDED AT THE TIME, I WOULD</b> <b>ALWAYS MAKE SURE TO GO TO THE</b> <b>LEVEL OF CARE THAT THE PATIENT</b> <b>NEEDED.</b> <b>THAT'S OUR TRAINING.</b> <b>>> YOU ARE THE PERSON IN THE</b> <b>ROOM WHEN NOBODY ELSE CAN BE IN</b> <b>THE ROOM, I IMAGINE.</b> <b>>> EXACTLY.</b> <b>>> THAT'S A BIG ROLE OF PAS.</b> <b>PATTI CUARTAS FROM THE NEW YORK</b> <b>STATE SOCIETY OF PAS, THANK YOU</b> <b>SO MUCH.</b> <b>>> THANK YOU FOR HAVING ME.</b>