To ease health care shoratge, lift limits on physician assistants
Patients in marginalized communities are the first to grapple with the shortage of primary care clinicians in New York state. But despite the persistent shortage of primary care providers, there is a motivated and available workforce in New York ready to meet the needs of patients.
Many New Yorkers are already familiar with physician assistants, and routinely see one for their primary care. But they may be unaware of the barriers to practice these providers face.
Gov. Kathy Hochul recognized the vital role of physician assistants during the pandemic and workforce crises, and she temporarily removed the requirement that PAS must be supervised by physicians.
This flexibility empowered PAS to meet challenges and provide high-quality, safe patient care in diverse settings. It also allowed health care systems to deploy PAS where they were most needed, unencumbered by administrative rules that have not kept pace with physician assistants’ evolving role in health care.
Gov. Hochul advocated for permanently removing these unnecessary barriers in her 2023 budget proposal. Unfortunately, these reforms were not enacted — but the governor is again including PAS as part of her 2024-25 agenda.
This is good news for New York, because despite having 29 educational programs in
New York that train physician assistants, the state faces challenges in retaining graduates. An informal survey of New York PA programs revealed that only about 70% of graduates remain in the state. Removing barriers to practice and allowing physician assistants to practice at the top of their license is a key factor in facilitating retention and recruitment.
Six states already allow PAS
by the CDC provides an additional justification for the medication: Antiviral treatment represses viral replication, and increased treatment with Paxlovid averts onward coronavirus transmission.
With such compelling rationale for its use, why isn’t Paxlovid prescribed more? I think it’s because health professionals and patients alike are misjudging the drug’s riskbenefit calculation. They are overemphasizing the treatment’s potential risk while underestimating the seriousness of COVID.
I often hear from clinicians that they are hesitant to prescribe Paxlovid because of its side effects, especially the possibility of “rebound” symptoms. Though it’s true that some patients who receive the antiviral might experience a recurrence of symptoms a week or so after they initially improve, two recent systematic reviews by the CDC and the Food and Drug Administration found no consistent association tying Paxlovid use to rebound. Other side effects from the drug, such as nausea, diarrhea and metallic aftertaste, might be annoying, but they are temporary.
Some clinicians might also balk at how the pills interact with other medications their patients are on. The FDA estimates that as many as half of VA and Medicare enrollees are taking medications or have conditions that cause trouble alongside Paxlovid. But the FDA also says that most of these interactions can be managed. For instance, someone taking certain cholesterol medications can stop them temporarily.
A national initiative targeting health professionals should emphasize the importance of early treatment. Insurers and hospital systems can also change their policies and workflows to flag patients eligible for Paxlovid. Clinicians should have to justify each time they choose not to prescribe antiviral therapies to patients 65 and older and to those with chronic medical conditions that predispose them to severe illness from COVID-19.
It’s remarkable that science has delivered exceptional breakthroughs that have dramatically reduced severe illness and death from the coronavirus. The great tragedy is our continuing failure to take advantage of these advances.