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In looking at reforming healthcare, we need to increase the productivity of all members of the care team, including physician assistants.
In a recent New York Times op-ed, "No There Won't Be a Doctor Shortage," authors and physicians Scott Gottlieb and Ezekiel J. Emanuel discussed the physician shortage in the U.S. and made recommendations about what we as a nation should do about it. They concluded:
Policy changes will be necessary to reach the full potential of team care.
That means expanding the scope of practice laws for nurse practitioners and pharmacists to allow them to provide comprehensive primary care; changing laws inhibiting telemedicine across state lines; and reforming medical malpractice laws that force providers to stick with inefficient practices simply to reduce liability risk. New payment models must reward investments in technologies that can save money in the long run. Most important, we need to change medical school curriculum to provide training in team care to take full advantage of the capabilities of nonphysicians in caring for patients.
Instead of building more medical schools and expanding our doctor pool, we should focus on increasing the productivity of existing physicians and other healthcare workers while incorporating new technologies and practices that make care more efficient. With doctors, as with drugs or surgery, more is not always better.
While I’m sure that it was an oversight, the above exclusion of physician assistants (PAs) does not recognize the meaningful and critical role that more than 93,000 PAs play each and every day in our healthcare system.
Of the three professions who provide direct patient care - physicians, PAs, and nurses - PAs are best positioned to rapidly increase the number of medical clinicians in the United States at an average of 27 months of training at the graduate level. Nearly 7,000 PAs matriculate from 181 PA programs annually and enter the clinical practice of medicine because we are educated similarly to physicians. There are another 63 programs in the accreditation pipeline, as well.
The scope of practice expansions advocated by the authors is a tricky and controversial subject, and can become a lightning rod of opposition for physician groups. Research shows that PAs and NPs do very well in all the settings in which they practice medicine and nursing. An independent review of research concluded that people hold consistently positive views about PAs as healthcare providers and are satisfied with the care provided by PAs. (BMC Health Services Research, 2013)
There is no doubt in my mind that my physician surgeon partner has vastly more training and education that I do. PAs are acculturated to practice in teams, and are trained to have a healthy respect for their individual limitations. PAs with the right training and experience can work effectively and at a high level in virtually every setting and every specialty, vastly improving the reach and quality of the healthcare teams.
How is it that PAs can be so effective if they don’t spend as long in medical school as physicians? The day-to-day practice of medicine has its foundation on pathophysiology, but relies on “pattern recognition,” which only comes from thousands of patient interactions. I’m not a physician, but through years of experience in an SICU burn unit and reconstructive surgery practice, I have developed a significant level of expertise in my area of practice that allows my surgeon partner to be confident in knowing that I can handle critically ill patients and make the same decisions that he would, when he can’t be right beside me.
Everything that the authors talked about in their op-ed are critical components to the continued reform of the American healthcare system. Technology, regulation, and quality issues have to be addressed to remove the barriers between patients and their providers in improving the efficiency and safety of the healthcare system. We still need to train more physicians, PAs, and other healthcare providers. We need to ensure that the policies of the healthcare system better match the human resources represented by direct patient care providers with areas of need. We also need to continue to remove legislative barriers to the quality care provided by PAs. Thirty-three states and the District of Columbia made PA-positive changes to laws in 2013. The Affordable Care Act attempts to jump start this process on many levels, and shift the focus of the healthcare system to one that is more patient centered.
I do believe that every physician, PA, and other provider should be allowed to practice to the top of their education and experience, and anything less than that will not achieve the promise of team practice in medicine. Increasing the productivity of every member of the team is critical to reaching this goal, and providing needed care to all of our patients.
This blog was provided in partnership with the American Academy of Physician Assistants.