Visits to the Stead Center are by appointment only. Please call the NCAPA office for more information. Read More »

Visits to the Stead Center are by appointment only. Please call the NCAPA office for more information. Read More »

The Pulse | July 2013

In this issue:
President’s Message: Don Metzger, PA-C
Apply to Serve on an NCAPA Committee–Deadline August 9
Important News for New Grads about Licensing
Government Affairs Update
Membership Update
2013 Summer Conference: Register Now
AAPA Alert: Allow PAs to Order Home Health Services
Toward Accountable Care
PAPA Fall Seminar
News from the Physician Assistant History Society
Upcoming Leadership Workshops
PAEC: Join the One-Hour Campaign


President’s Message

By Don Metzger, PA-C

Greetings. This issue of the pulse is packed full of important information that affects your ability to practice medicine. Your NCAPA is actively engaged in monitoring legislation, policy, and the changing environment in healthcare with the implementation of the Affordable Care Act. Please share this information with your colleagues and encourage them to join the NCAPA.

If you have not made plans to attend the 37th NCAPA Annual Summer Conference at Kingston Plantation, you will need to do so ASAP as we are quickly filling up. We will also be holding a special reception for our NC “PA of the Year” to be announced at the conference. So make plans to attend.


Apply to Serve on an NCAPA Committee–Deadline August 9

Being a member of NCAPA offers great leadership opportunities.  We encourage you to become more involved by volunteering to serve on a Committee.  NCAPA is seeking applications for Committee Chairs and Committee Members.  Everyone interested in serving on a Committee in 2014 must complete an application and return it to NCAPA by August 9.  Even current Committee Chairs and Committee Members must submit an application expressing their interest in continuing to serve in 2014.

Committee Chairs will be selected at the meeting of the NCAPA Board of Directors on August 17.  Within three weeks of being appointed, Chairs will select members for their Committees from among the applications submitted.  Terms are for one year beginning January 1, 2014.  Serving on a Committee is a great way to influence the policies and programs of NCAPA and gain valuable leadership experience and camaraderie with your fellow PAs.  Submit your application today!


Graduating Soon? Avoid Trouble with the Medical Board Before Starting Your Job!

For many students in PA programs across North Carolina, graduation means taking (and passing) the PANCE, settling into a new city, and preparing to begin work as a practicing physician assistant.  It is very often the case that your employment start date occurs before your license to practice is issued by the North Carolina Medical Board.  Unfortunately, this is a time when you as a new PA can find yourself in serious trouble with the Medical Board.

As you prepare to practice, please keep in mind that new physician assistants must accomplish the following in order to begin the practice of medicine:

  • Complete an accredited PA program
  • Pass the PANCE
  • Fully complete and submit the PA licensing application
  • Receive a license to practice
  • Complete an Intent to Practice form on the Board’s website and confirm that the Board has received and processed this form

Also, remember that you must apply for and receive a DEA license in order to prescribe controlled substances.

Recently, it has come to our attention that the North Carolina Medical Board has disciplined a number of new PAs for practicing medicine without a license.  Much of the time, these PAs are not doing anything malicious – perhaps they are taking histories or collecting vital signs prior to becoming fully licensed.  Such actions, however, still constitute practicing without a license.  In many cases, this has resulted in a Public Letter of Concern, which remains on a licensee’s record for the rest of his/her career (the Board has the discretion to determine which penalties are applied, so they may be more or less severe).  Additionally, this action will almost certainly have to be disclosed when applying for a license in another state, applying for hospital privileges, etc.    It is conceivable that such an action on a physician assistant’s record could lead to denial of licensure, difficulty or inability to obtain hospital privileges, and/or failure to receive accreditation with insurers.  Even if these negative consequences do not come to pass, having to continually explain this blemish is not only embarrassing, but requires a great deal of valuable time.

So, how can new PAs avoid falling into this trap?  It’s simple, really:  you are not allowed to perform any medical acts prior to completing the licensing steps listed above.  If you are planning to work in your practice prior to becoming fully licensed, you are likely in violation of the rules if anything you do gives the appearance of practicing without a license.  This can be a difficult concept since new graduates without a full license actually have fewer privileges than students in terms of performing medical acts.  Our best advice:  if you are not fully licensed, you should not be interacting with patients in any capacity in your new practice.

An excellent discussion written by Katharine Kovacs, a PA on the NCMB staff, and Jane Paige, a licensing coordinator at the NCMB, can be found here:

Please take a few minutes to read this informative – and brief – article.  As always, we at the NCAPA stand ready to answer any questions you may have.  The NCAPA Government Affairs Committee wishes you much success as you begin your new career!


Government Affairs Committee Report

Update on North Carolina Division of Medical Assistance and PA Enrollment. As of July 1, NCTracks is up and running. PAs need provider numbers to be enrolled in NCTracks. July 1 was also supposed to be the deadline that if a PA was not credentialed in Medicaid with the Division of Medical Assistance then their prescription would not be filled (or the patient would have to pay out of pocket). We are interested in knowing your experiences with NCTracks, credentialing and prescription filling. Please contact the Central Office ( and let us know what is going on across the state.

Update on Legislation

HB 18 is legislation that seeks to raise the minimum age for legal use of tanning equipment without a prescription from 14 to 18 years of age. The bill specifically names PAs as healthcare providers who may lawfully prescribe the use of such equipment for those individuals under the age of 18. This has passed the House and currently is still in the Senate.

SB 83 is legislation that seeks to encourage volunteer health care in free clinics by limiting the liability of health care providers if the free clinic posts a notice of limited liability. This immunity from liability would not apply in those instances where it is established that a patient’s injuries or death were caused by gross negligence, wanton conduct, or intentional wrongdoing on the part of the health care provider. This has passed Senate and House. PAs were added by name to this bill through intervention of NCAPA.

Legislation applicable to providers, to include PAs:

SB 20  concerns Naloxone access and is a Good Samaritan bill. Under the legislation, a practitioner acting in good faith and exercising reasonable care may directly or by standing order prescribe an opioid antagonist to (i) a person at risk of experiencing an opiate-related overdose or (ii) a family member, friend, or other person in a position to assist a person at risk of experiencing an opiate-related overdose. The bill would also provide immunity from civil or criminal liability to practitioners who prescribe an opioid antagonist under the aforementioned circumstances. This passed the House and Senate and is now signed to law.

HB 70 seeks to enact the North Carolina Health Plan to provide coverage to all state residents with comprehensive health benefit coverage as an alternative to a health benefit exchange. Under the bill, the plan will not charge deductibles or co-payments for the first two years. After that, if implemented such charges may not exceed $250 (single plan) or $500 (family plan) respectively. The plan would also offer a direct billing system for providers. Providers who participate in the direct billing system would be entitled to payment for services within 30 days of providing them. Sitting in House committee. Never made crossover deadline and will die at the end of this session.

SB 106/HB 154 seek to enact the Home Birth Freedom Act and would license individuals to be certified professional midwives. The bill creates exemption from licensure requirements for other healthcare providers to include PAs. Sitting in Senate committee. Never made crossover deadline and will die at end of session.

SB 555 seeks to remove nurse practitioners from being regulated by the North Carolina Medical Board. Sitting in Senate committee. Never made crossover deadline and will die at the end of the session.

SB 222 mandates use of a controlled substance reporting form. Requires reporting of dispensing of controlled substance within 3 business days, but ideally within 24 hours to the North Carolina Controlled Substance Reporting System. It also allows a prescriber to delegate to someone else the ability to look up this information. This was passed to law.

SB 256 an act to confirm physician supervision of all nurses providing anesthesia services. Sitting in Senate Committee. Never made crossover deadline. Will die at the end of session.


Membership Update

by Wanda Hancock, MHSA, PA-C

There was a meeting of the Membership Committee in April at the Stead Center. We looked at industry research and approaches to membership development and retention. As a result, we have several initiatives that will be rolled out during and following the summer conference. One of our projects is in the form of a booth at the conference that will be an attempt to make contact with our members to let them know the benefits of membership and to answer any questions or concerns of members. We hopefully will get some feedback that will allow us to better develop our membership “package”. We are also launching an “Each One Reach One” campaign with the idea that those PAs who are already members can best make contact with other PAs to encourage membership. With regard to advocacy, having a large percentage of practicing PAs as members is a key factor, and research (industry and our own) has shown that advocacy is the most important function of our organization. We are excited about our campaign and hope to be able to report the benefits reaped in the next few months.

Another important aspect of membership development is recognition of members who are contributing to our success and forward progress. NCAPA’s President, Don Metzger, announced the resurrection of the PA of the Year award at the beginning of the year. This was right on target with what the Membership Committee wants to accomplish. The Committee developed criteria for the award, and these were approved by the Board of Directors at their April meeting. A group of five (board members and appointees) is currently evaluating the five nominations for the PA of the Year award, with anticipation of presenting the award at the annual conference.

Our final activity of the year will be to combine the Regional Chapter Committee with the Membership Committee. This was an action taken by the board of directors earlier this year. The committee will meet during the annual conference to develop the plans and goals of for the 2014 year. Any recommendations or suggestions to help us with this task would be greatly appreciated (email your thoughts to us by August 15, please).

Over the past months, Lee Busselman, NCAPA Member Services Coordinator, has been a tremendous asset to our committee. He takes our random thoughts and makes them work! There has been a lot thrown at him this year and like the Engergizer Bunny, he “takes a licking and keeps on ticking”! We have been amazed at how easy he has made our job of developing the Membership Committee activities this year. Kudos to Lee!


2013 Summer Conference

AAPA Category 1 CME Approved: 40+ Hours for PAs, NPs, and ATCs*

Register NOW–Rates Go Up August 1


NCAPA 37th Annual Summer Conference
August 18 – 23, 2013 ~ Kingston Plantation Embassy Suites ~ Myrtle Beach, SC
  • Have you heard 82% of our attendees come back year after year? Come be a part of the NCAPA family!
  • You’ve asked and we are delivering. Each lecture will have at least one case study to maximize your learning.
  • Where else can you get five breakfasts, four lunches, and two receptions ALL INCLUDED with your conference registration? Guest packages include these meals as well, so feed the family!
  • Our sessions start early and end early so you can get outdoors and enjoy the miles of beautiful beaches and all that the Kingston Plantation and Myrtle Beach have to offer. With tournaments on the beach each afternoon, SPLASH! Waterpark, eight pools, a lazy river, tennis, volleyball, and more, we promise you will have a great time and make new friends!

*The Physician Assistant Review Panel is pleased to announce that a total of 65 hours of AAPA Category 1 CME credit will be presented at the 37th Annual NCAPA Summer Conference provided by the North Carolina Academy of Physician Assistants. Conference attendees can select from sessions to earn a maximum of 41 hours of Category 1 CME credit.


AAPA Alert: Allow PAs to Order Home Health Services

The AAPA is urging all PAs to contact their legislators and tell them the importance of ensuring access to home health services by allowing PAs to order home health for Medicare beneficiaries.  Go to the AAPA Legislative Action Center and contact your legislators today!



What is “SCOPE of Pain?”  SCOPE stands for Safe and Competent Opioid Prescribing Education.  SCOPE of Pain is a series of continuing medical education activities designed by Boston University Medical Center to help you safely and effectively manage patients with chronic pain, when appropriate, with opioid analgesics. The program consists of:

  • A 3-module web-based activity;
  • 10 live conferences held around the US that will include Policy and Resource Panels; and
  • Train-the-trainer sessions, and a subsequent trainer-delivered series of hospital/community health center based grand rounds workshops.

The FDA has mandated manufacturers of extended release/long-acting (ER/LA) opioid analgesics, as part of a comprehensive Risk Evaluation and Mitigation Strategy (REMS), to make available comprehensive prescriber education in the safe use of these medications based on the FDA curriculum known as the Blueprint for Prescriber Education for Extended Release and Long-Acting Opioid(ER/LA) Analgesics. The Boston University Medical Center curriculum covers all aspects of this blueprint and more to provide a comprehensive educational program.

The North Carolina Medical Board, Boston University Medical Center, and the North Carolina Medical Society have joined together to sponsor a Scope of Pain CME event at the Raleigh Marriott on Friday, October 25 in conjunction with the NCMS Annual Meeting.  NCAPA is a collaborating partner for this training, along with other medical organizations in the state.  For more information and to register, visit these websites: or


Toward Accountable Care

Over 30 North Carolina medical societies and organizations joined together in a commitment to helping the medical community face the challenges of a changing health care environment, launching the Toward Accountable Care Consortium and Initiative. The Consortium was designed to provide the medical community with the knowledge and tools needed to understand, participate in, navigate, lead, and succeed in a value-driven health care system.  NCAPA is a member of the Consortium.

Consortium members believe it is better to be engaged in discussions about changes to our health care system and help influence those changes than to sit back and be subject to someone else’s vision.  Whether in independent practice or employed by a hospital or health system, clinicians need to be fully engaged in designing how care is delivered in their community. The government and private sector are looking to clinicians to help develop new models of care that will reduce waste, increase quality, and control costs. This Initiative is designed to help you do just that.

Over the next few years, the Consortium will provide information, resources, and tools to our members, using many different mediums to accommodate as many learning preferences and time constraints as possible. We will highlight what is working and what is not.  Recognizing that no one model of care is right for every medical community, most of the resources will be focused on general principles promoting patient-centered, value-driven health care, although guidance also will be developed for specific programs that are gaining traction, such as the CMS Shared Savings Program, the CMS Advanced Payment ACO Model, and bundled payments.

What is Accountable Care?

An ACO is a provider-based organization that takes responsibility for meeting the healthcare needs of a defined population with the goal of simultaneously improving health, improving patient experiences, and reducing per capita costs. An ACO must have a strong primary care foundation, and also may integrate other specialists, hospitals, nursing homes, etc. to promote a high degree of care coordination.  Click here for an article about Accountable Care Organizations:

This information was taken from the new TAC Consortium website.  We encourage you to visit the website to learn more about the Consortium and ACOs that are working in North Carolina.


PAPA Fall Seminar

The Piedmont Association of Physician Assistants is offering a FREE Fall Seminar on Saturday, September 21, at the Forsyth Medical Center in Winston-Salem. This conference will provide six hours of Category I CME approved by the AAPA, and is open to all Physician Assistants and Nurse Practitioners. The conference will consist of six one hour-lectures, breakfast, snacks, lunch, and access to multiple exhibitors. Please direct any and all questions to PAPA Information.


News from the Physician Assistant History Society (PAHS)

By Tom Piemme, MD

President, PAHS Board of Trustees

The Physician Assistant History Society has now experienced more than a full year of operation at our headquarters in Atlanta. It has been an extraordinary year. The archival collection has been expanded, the website has been enhanced, and the Timeline is currently being updated. We have been able to digitize our entire audiovisual collection, and are now engaged in transcribing many of the more informative interviews and recorded dialog that we will post on the website. We invite you to visit our website, which is becoming a rich searchable database on the profession.

The most important achievement, however, has been the publication of our new book, entitled, The Physician Assistant: An Illustrated History. Authored by Fred Sadler, Reg Carter, Ruth Ballweg, and myself, the book incorporates elements of the website Timeline, together with abstracted “bio-sketches,” photos, and graphics. It is a concise history of the people, places, and events that have propelled the concept of the physician assistant from its inception at Duke University in 1965 to its position as a major force in American medicine today.

Although there are good discussions of history in existing textbooks, this effort provides a concise, readable, low-cost handbook that can be used by programs and students to meet the requirements of accreditation, and by practicing PAs to reacquaint themselves with the precedents that propel the profession today.

Use this order form to purchase copies of the book. While the list price is $15.95, we are offering the book to constituent organizations and their members for $12 per copy or $10 per copy for orders of 15 or more.

The Society is a 501c(3) tax-exempt organization that relies on support from PA organizations, education programs, specialty organizations, special interest groups, and from individual donors who wish to support the work of the Society.


Upcoming Leadership Workshops
By Alisha DeTroye, PA-C

Are you uncertain how to best get more involved in NCAPA or your local PA organization? Are you a new PA graduate who would like to get your feet wet in a leadership position? Have you served in PA leadership for years and need some new ideas? Then you’ll want to save the date of September 7 for PA Leadership Boot Camp. There will also be a Regional Chapter Workshop for current Regional Chapter Leaders and those who want to get more involved in regional PA organizations on September 8.

Through my involvement in the NCMS Leadership College, I’m organizing these two events for the fall. If you are interested in participating, please email me ( and I’ll send you updates as they become available.


PAEC One-Hour Campaign: Give A Little, Help A Lot

Be an active contributor to your PAEC!  Advocacy is a dynamic and on-going process. It doesn’t start or stop on Election Day. We advocate for our profession throughout the year to develop and enhance our legislative relationships.

Join the Campaign: Please consider contributing to the PAEC. Donating just one hour of your salary each year can have a huge impact on your professional practice throughout your career. Please challenge your colleagues to do the same and help champion the goals of the PAEC. Please help preserve, strengthen and expand the PA practice in North Carolina!