States Lift More Hur­dles To Physi­cian As­sis­tants

ForbesWeekly - - NEWS - BY BRUCE JAPSEN, FORBES CON­TRIB­U­TOR FOL­LOW BRUCE JAPSEN AT www.forbes.com/sites/bruce­japsen

An un­prece­dented num­ber of reg­u­la­tory hur­dles are fall­ing for physi­cian as­sis­tants seek­ing more au­ton­omy in their ef­forts to treat pa­tients.

In some cases, states are eas­ing bar­ri­ers that in the past led to re­dun­dant tasks or slowed the abil­ity of pa­tients to get the care they needed in a timely fash­ion. Such changes to reg­u­la­tions or scope of prac­tice laws are tak­ing ef­fect this year as the re­sult of state leg­isla­tive ses­sions com­pleted this sum­mer.

“In 2016, ev­ery state made at least one PA-pos­i­tive change to their laws or reg­u­la­tions (and) this ti­dal wave of sup­port is con­tin­u­ing in 2017,” Jenna Dorn CEO of the Amer­i­can Acad­emy of PAs said of the myr­iad leg­isla­tive and reg­u­la­tory changes. “State and fed­eral law­mak­ers rec­og­nize the value of the PA pro­fes­sion and un­der­stand that re­mov­ing out­dated PA prac­tice bar­ri­ers en­hances pa­tient ac­cess to care.”

Like nurse prac­ti­tion­ers and al­lied health pro­fes­sion­als in gen­eral, bar­ri­ers to PAs are fall­ing for a va­ri­ety of rea­sons in­clud­ing a doc­tor short­age and gen­eral com­fort U.S. pa­tients have with be­ing treated by some­one other than a physi­cian.

PAs work in doc­tor’s of­fices, clin­ics, hos­pi­tals and other lo­ca­tions and their work in­cludes di­ag­nos­ing ill­nesses, writ­ing pre­scrip­tions and coun­sel­ing pa­tients on pre­ven­tive care. There are now more than 40 states that have im­ple­mented “full pre­scrip­tive au­thor­ity” for PAs with the ad­di­tion in the last year of Maine and Florida.

In many cases, state rules date back to a time when there were few PAs and pa­tients got their care mostly from a physi­cian. To­day there are more than 115,000 PAs com­pared to 20,000 in 1990.

In Illi­nois, where it took the state two years just to pass a bud­get, Gov. Bruce Rauner last month signed into law a 10-year ex­ten­sion to 2028 of the state’s PA Prac­tice Act to bet­ter reflect the re­la­tion­ship be­tween PAs and physi­cians. The Illi­nois reg­u­la­tion “re­places ref­er­ences to ‘su­per­vis­ing physi­cians’ with ref­er­ences to ‘col­lab­o­rat­ing physi­cians’ through­out the Act,” the Illi­nois Gen­eral Assem­bly’s lan­guage in the bill says.

“This leg­is­la­tion brings the lan­guage of the Physi­cian As­sis­tant Prac­tice Act in line with that of other li­cen­sure acts,” said Dr. Nestor Ramirez, pres­i­dent of the Illi­nois State Med­i­cal So­ci­ety, which rep­re­sents physi­cians and sup­ported the act. “Pa­tients are best served by physi­cian-led teams of pro­fes­sion­als prac­tic­ing within the scope of their li­cen­sure, and physi­cians work col­lab­o­ra­tively with PAs and other al­lied health care pro­fes­sion­als to en­sure that the care pro­vided is of the high­est qual­ity.”

PAs and law­mak­ers pass­ing such leg­is­la­tion say they are es­sen­tially grant­ing physi­cian as­sis­tants the abil­ity to do what they are trained to do. Most have a two-year mas­ter’s de­gree, of­ten from a pro­gram that runs about two years and in­cludes three years of health­care train­ing, ac­cord­ing to the AAPA.

In­creas­ingly, PAs are find­ing them­selves more closely in­te­grated with the team-based ap­proach to health­care de­liv­ery as in­sur­ers shift pay­ments to providers to value-based mod­els from fee-for-ser­vice medicine.

The team-based ap­proach that in­cludes PAs is fig­ur­ing into de­ci­sions by med­i­cal ed­u­ca­tors to have them work more closely with physi­cians-in-train­ing. Stan­ford Univer­sity re­cently un­veiled the first class in a new 30-month Mas­ter’s de­gree pro­gram that “em­pha­sizes train­ing for physi­cian as­sis­tants along­side med­i­cal stu­dents for course­work and clin­i­cal care.”

The ac­cep­tance of PAs has led to an un­prece­dented de­mand to hire the pro­fes­sion at hos­pi­tals, clin­ics and other health fa­cil­i­ties, re­cruiters say.

“Place­ments of ad­vanced prac­tice clin­i­cians, pri­mar­ily PAs, have grown steadily since 2012,” said An­drea Cle­ment, spokes­woman for The Medi­cus Firm, a na­tional health­care staffing firm. “In 2016, non-physi­cian, ad­vanced prac­tice place­ments com­prised 12% of to­tal provider place­ments, up from 8.3% in 2015. Physi­cian as­sis­tants were the se­cond-most fre­quently placed provider in 2016.”

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