[Congressional Record Volume 154, Number 83 (Tuesday, May 20, 2008)]
[House]
[Pages H4183-H4185]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   ESTABLISHING POSITION OF DIRECTOR OF PHYSICIAN ASSISTANT SERVICES

  Mr. HARE. Mr. Speaker, I move to suspend the rules and pass the bill 
(H.R. 2790) to amend title 38, United States Code, to establish the 
position of Director of Physician Assistant Services within the office 
of the Under

[[Page H4184]]

Secretary of Veterans Affairs for Health, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 2790

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. ESTABLISHMENT OF DIRECTOR OF PHYSICIAN ASSISTANT 
                   SERVICES AT VETERANS HEALTH ADMINISTRATION OF 
                   DEPARTMENT OF VETERANS AFFAIRS.

       (a) In General.--Section 7306(a) of title 38, United States 
     Code, is amended by striking paragraph (9) and inserting the 
     following:
       ``(9) The Director of Physician Assistant Services, who 
     shall be a qualified physician assistant who shall report to 
     the Under Secretary for Health on all matters relating to the 
     education and training, employment, appropriate utilization, 
     and optimal participation of physician assistants within the 
     programs and initiatives of the Administration. The Director 
     of Physician Assistant Services shall serve in a full-time 
     capacity at the Central Office of the Department.''.
       (b) Deadline for Implementation.--The Secretary of Veterans 
     Affairs shall ensure that an individual is serving as the 
     Director of Physician Assistant Services under section 
     7306(a)(9) of title 38, United States Code, as added by 
     subsection (a), by not later than 120 days after the date of 
     the enactment of this Act.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Illinois (Mr. Hare) and the gentleman from Florida (Mr. Miller) each 
will control 20 minutes.
  The Chair recognizes the gentleman from Illinois.
  Mr. HARE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am pleased that the House today is considering H.R. 
2790, a bill I authored to elevate the current position of Physician 
Assistant Advisor to a full-time Director of Physician Assistant 
Services in the VA Central Office.
  I would like to thank my good friend Representative Jerry Moran for 
leading the effort with me, as well as Chairman Filner and Ranking 
Member Buyer for their cosponsorship of this legislation. I'd also like 
to acknowledge all of my colleagues on the Veterans' Affairs Committee 
who joined as cosponsors and the American Academy of Physician 
Assistants for their tireless work on this bill.
  Mr. Speaker, there are currently 1,600 physician assistants serving 
the Veterans' Health Administration, including many veterans, National 
Guard, and Reservists. PAs are a critical component of the health care 
delivery system and are responsible for roughly one-quarter of all 
primary care patients seen in the VHA.
  The change from the current role of PA Advisor, who works part time 
and is based in the field, to a full-time Director is necessary in 
order to ensure that PAs are being appropriately and effectively 
utilized throughout the VHA. Right now the PA Advisor is being left out 
of strategic planning discussions and long-term staffing narratives, 
leaving PAs with no voice and no advocate. Additionally, there is a 
severe disparity throughout the VA facilities in how PAs are being 
used, what medical services they can perform, and even whether 
facilities can hire physician assistants. Most importantly, the 
unnecessary restrictions and widespread confusion are causing the VA to 
miss a clear opportunity to improve the quality of health care for our 
veterans.
  One of the biggest challenges facing current and future PAs in the VA 
system is their exclusion from any recruitment and retention efforts or 
benefits. The VA designates certain positions, such as physicians and 
nurses, as critical occupations, which are given priority in loan 
repayment and scholarship programs. Since PAs are not designated as a 
critical occupation, they are excluded from these moneys, despite the 
fact that the VA has determined that physician assistants and nurse 
practitioners are functionally interchangeable and equal in the work 
that they perform. The underutilization, the lack of recruitment and 
retention efforts, and pay disparity are all leading PAs to not 
consider the VHA as a viable employment option.
  Physician assistants are very important for veterans living in rural 
areas, like a large portion of my congressional district. Veterans that 
live in underserved areas made the same sacrifices as their urban and 
suburban counterparts. With a disproportionate number of these brave 
men and women being cared for by PAs, it is critical that we establish 
a system that will best serve their needs so as not to compromise care 
to our veterans. Considering the fact that nearly 40 percent of all VA 
PAs are projected to retire in the next 5 years, the VA is in danger of 
losing its physician assistants workforce unless some attention is paid 
to this critical group.
  This bill will allow the Director of Physician Assistant Services to 
become an integral component within the VA system to proactively solve 
the many issues facing PAs and give PAs a fair and long overdue voice.
  Mr. Speaker, this commonsense legislation promotes quality medical 
care for our veterans. I urge my colleagues to support it.
  Mr. Speaker, I reserve the balance of my time.
  Mr. MILLER of Florida. Mr. Speaker, I yield myself such time as I may 
consume.
  As Memorial Day approaches, it's appropriate that we take time this 
week to consider the next 10 bills that are on the suspension calendar. 
In doing so, we must be mindful of the heavy sacrifices made by the men 
and the women of our Armed Forces. It is their sacrifices that allow us 
to enjoy our American way of life and time-honored traditions like 
Memorial Day.
  For many of us, Memorial Day will be marked with a solemn 
commemoration at a veterans' cemetery or a befitting memorial. I 
appreciate Chairman Filner's expediting these bills through the 
committee process to bring them to the floor in a timely fashion.
  Mr. Speaker, I rise this afternoon in support of H.R. 2790, as 
amended, a bill to establish the position of Director or Physician 
Assistant Services within the office of the Under Secretary of Veterans 
Affairs for Health. I commend my colleagues Mr. Hare and Mr. Moran for 
introducing this bill.
  There is a strong relationship between military service and the 
physician assistant profession. In 1965 Duke University established the 
first PA education program to capture the knowledge of military medical 
corpsmen that served in Vietnam and transition their experience into 
the civilian health care system. Today the VA is the largest employer 
of physician assistants, and they play a central role in enhancing 
veterans' access to health care, and it's important for VA to continue 
to advance the utilization of these health care providers.
  Establishing this office would be beneficial to veterans. A full-time 
Director would ensure PAs are used appropriately to provide veterans 
the health care that they deserve. I urge my colleagues to support this 
bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. HARE. Mr. Speaker, I would like to recognize my friend from New 
Hampshire (Ms. Shea-Porter) for such time as she may consume.
  Ms. SHEA-PORTER. Mr. Speaker, I'd like to take this opportunity to 
thank the sponsor of this legislation, the gentleman from Illinois, 
Phil Hare, who's a leader and a tireless advocate for veterans.
  This Memorial Day we honor the memory of so many who have served this 
Nation. In honor of their memory, it's fitting that we consider 
legislation today that will help deliver the benefits that were 
promised to our veterans and which they earned by their selfless 
service to our Nation.
  The bill before us, H.R. 2790, will create the position of Director 
of Physician Assistant Services in the VA to manage the education, 
training, and utilization of physician assistants within the Veterans 
Health Administration.
  PAs play an important part in the health care of our veterans, 
providing a whole range of diagnostic and therapeutic services, 
administering physicals, taking patient histories, diagnosing and 
treating patients. The first PAs were former corpsmen who had served in 
Vietnam. Their extensive medical training made them ideal candidates 
for further medical education and the perfect fit for the continuing 
medical care of their fellow veterans. Since the PA Advisor position 
was created in the VA in 2000, their ranks have grown, and today almost 
1,600 PAs serve in the VA.
  PAs go through a very vigorous 2-year-long certification program, and 
by creating a Director of Physician Assistant Services in the VA, we 
can help

[[Page H4185]]

ensure that their expertise is properly utilized and that our veterans 
receive the care they deserve. Their utilization may also mean in rural 
States like mine that veterans have greater access to health care.
  It's appropriate that we will pass this legislation today in honor of 
the veterans who have served our country so bravely. As a proud wife of 
a veteran myself, working to improve the care veterans were promised 
and have earned is a top priority for me, and I enthusiastically 
support this legislation. I urge my colleagues to support this also.
  Mr. MILLER of Florida. Mr. Speaker, I have no further requests for 
time, and I yield back the balance of my time.
  Mr. HARE. Mr. Speaker, I urge my colleagues to unanimously support 
H.R. 2790, as amended.
  Mr. MORAN of Kansas. Mr. Speaker, I want to thank Congressman Hare 
for his leadership on passage of this bill and my colleagues and staff 
on the House Veterans Affairs Committee for their support. I joined 
Congressman Hare as an original cosponsor of H.R. 2790. This bill 
creates a full-time Director of PA Services within the Department of 
Veterans Affairs. This legislation is beneficial in improving patient 
care for our Nation's veterans, ensuring that the 1,600 PAs employed by 
the VA are fully utilized to provide veterans medical care.
  As a Member of Congress who represents one of the most rural 
districts in the country, I know that physician assistants are a key to 
providing medical care in underserved areas. Often, they are the only 
health care professional available. PAs help ensure those who live in 
our communities receive timely access to quality health care.
  I want to be certain that PAs are appropriately utilized by the VA to 
serve our veterans. Like our armed forces that have full-time directors 
of PA services, this legislation will establish a dedicated expert in 
the VA Central Office. This PA Director will work to fully integrate 
the profession into VA health care, ensuring PAs have a stronger voice 
in the VA so they can better serve our veterans and their patients.
  Mr. HARE. Mr. Speaker, I have no further requests for time, and I 
yield back the balance of my time.


                             General Leave

  Mr. HARE. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days in which to revise and extend their remarks and 
include extraneous material on H.R. 2790, as amended.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Illinois?
  There was no objection.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Illinois (Mr. Hare) that the House suspend the rules and 
pass the bill, H.R. 2790, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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