A Vital Solution for Better Patient Care

Late last year, the Health Resources and Services Administration projected a shortage of nearly 190,000 physicians across specialties by 2037. They noted, however, that we could mitigate the lack of doctors in some specialties by increasing the use of physician associates (PAs), especially with new and pending legislation expanding PAs’ scope of practice. A new survey conducted by Morning Consult, a business intelligence company, and the American Academy of Physician Associates (AAPA) found that doctors mostly agree with this assessment.

Lisa Gables, CPA, chief executive officer of the AAPA, said, “anecdotally,” physicians have long heralded the value of PAs. But, with organizations like the American Medical Association (AMA) campaigning to end PA “scope creep,” the AAPA thought it was important to do a direct study. Most (90%) of physicians see PAs as important to enhancing care delivery.

“For change to happen — and to make sure we can continue to provide the best possible care for patients — all healthcare providers must work together to find solutions,” Gables told Medscape Medical News. “The doctors who work with PAs appreciate the work they do and recognize the barriers they face. But anecdotes aren’t data. We thought it was important to do a formal survey so physicians across the nation could share how they work with PAs and where we can find common ground to address the challenges healthcare is facing.”

The survey included a national sample of 999 physicians. It found that 86% of respondents, even those who do not work directly with PAs, believe that PAs can help expand access to care. Moreover, 68% of respondents said that they support modernizing PA laws and regulations to ease provider shortages and reduce wait times for patients.

Physicians Trust PAs

Currently, most laws dictate that physicians must supervise PAs as they work — yet, what constitutes supervision varies. The physicians surveyed said their PAs often see patients on their own in primary and specialty care settings. And 63% of the respondents reported never or rarely being physically present in the room while a PA delivers care. Gables said that while she is well aware of PAs’ strong skills and capabilities, she was surprised to see that this percentage was so high.

“The supervising agreement and supervision language that you see in so many state laws suggests that constant physician oversight is necessary. But in day-to-day practice, that’s not what is happening,” she said. “Physicians report they are rarely in the room with PAs during patient interactions and spend little time monitoring the care they provide. Physicians really trust their PAs — and it would be good to see laws that reflect that.”

PAs Improve Care Delivery 

One of the AMA’s arguments about the dangers of scope creep is that patients may come to harm if a physician is not directly involved with patient care. They say PAs may not have the training or experience to identify some issues or to understand when a referral is required. Yet, a significant number of physicians surveyed in the AAPA study stated that they believed PAs are trained to perform comprehensive history and physical exams (61%), make referrals (59%), diagnose conditions and other disease states (50%), and develop and implement treatment plans (48%).

This is important, said Gables, because those same physicians reported there aren’t enough healthcare providers available, and they are struggling with current patient loads. The survey highlights the need to find ways to improve not just access to care but care delivery itself — and, given their skill sets, PAs are in a prime position to help.

“Most healthcare providers today will tell you that they are overworked. There are shortages everywhere,” said Gables. “Physicians see that patients are having a hard time accessing healthcare. There are long waits for appointments. And they also see that PAs have the skills necessary to help alleviate those shortages. More than three quarters of the doctors who work with PAs say they provide safe, effective care to patients — and they know when they need to consult with a physician or make a referral,” she said.

Autonomy Leads to Access

The AAPA has long called for policy changes to lessen the barriers that make it harder for PAs to serve the needs of patients. Gables said that what they are advocating for is not what the AMA calls scope creep but rather to lessen different barriers that interfere with PAs helping to deliver care. And it appears that physicians also see the value in loosening PA-related practice policies. About 68% of respondents said they support removing mandatory physician agreements to help ease provider shortages and improve care delivery for patients. Gables hopes that the AMA will see these results and think about ways providers can come together to make healthcare more accessible and equitable across the country.

“Looking at these results, I see that there’s the AMA, and then there’s the physicians who work with PAs. Those physicians know what PAs can do. And they know that we should all work together to solve the problems we share,” she said. “A previous survey shows that patients understand who PAs are and the value they bring to healthcare teams. Now we see that physicians understand that, too…So when we are thinking about how to make healthcare better, we all have a role to play in helping patients get the care they need and deserve.” Gables thinks we will be closer to achieving that when PAs practice at the highest levels of their training.

Kayt Sukel is a healthcare and science writer based outside Houston.