Growing Numbers of Physician Assistants May Help Cut Assembly Line Feel for Patients

It’s increasingly common that when you visit the doctor you’ll be seen first, and maybe exclusively, not by the person with the M.D. degree, but by another trained medical professional. According to a report commissioned by the Centers for Disease Control and Prevention, in 2009 nearly half of all office-based physicians practiced with nurse practitioners (NPs), certified nurse midwives (CNMs) or physician assistants (PAs).

And these days, the presence of PAs in hospital emergency departments (ED) is growing. According to a report published in Renal and Urology News, PAs treat approximately 1 in 10 patients who visit EDs each year.

Physician assistants must complete an accredited education program and pass a national exam in order to obtain a license. As described by the U.S. Bureau of Labor Statistics, PAs practice medicine under the supervision of M.D.s. They are trained to provide diagnostic, therapeutic and preventive health-care services. They work as part of a health-care team, taking medical histories, examining and treat patients, ordering and interpreting laboratory tests and X-rays and making diagnoses. They treat minor injuries, record progress notes, instruct and counsel patients, and order or carry out therapy. They may prescribe certain medications.

Some physicians have been uncomfortable with what they believe is a professional or legal threat posed by PAs. But that seems to be a minority view.

A study in the Journal of the American Academy of Physician Assistants sampled 1,000 emergency physicians in 2004 and again in 2009 about their perceptions of PAs in the ED. In 2004, about 720 respondents disagreed or strongly disagreed that PAs are more likely than physicians to commit medical malpractice, and 680 did so in 2009. In 2004, some 840 disagreed or strongly disagreed that PAs were more likely than M.D.s to be sued for medical malpractice; some 820 responded similarly in 2009.

In the five years between 2004 and 2009 the number of physicians who reported practicing with PAs increased by 1 in 4. And the number of physicians who believed the presence of PAs diminished patient waiting times in the emergency room grew by 13 in 100; the number who say PAs boost patient satisfaction rose by 1 in 10.

“Most emergency physicians agree that the increased utilization of PAs in the ED may improve patient communication, decrease wait times, increase patient satisfaction, and therefore decrease malpractice risk,” the authors wrote.

“[A]s physicians gain both clinical experience and experience working with PAs, their perception of malpractice risk imposed by the PA in the ED significantly decreases.”

The CDC report outlined where skilled medical helpers are found most often:

  • Primary care physicians were more likely to have NPs, CNMs or PAs than physicians of other specialties.
  • Physicians in larger and multi-specialty group practices were more likely to work with NPs, CNMs or PAs than those in smaller and single-specialty group practices.
  • Older physicians were less likely than middle-aged physicians to be in practices that included NPs, CNMs or PAs.
  • Physicians in practices with a higher proportion of revenue from Medicaid and a lower proportion from Medicare were more likely to work with NPs, CNMs, or PAs.

The CDC study noted that the Affordable Care Act — the health-care reform bill passed by Congress last year — includes funding for PA education in primary care, so more of those practices probably will be employing them. Because PAs often take more time with patients than the in-and-out, assembly-line experience that’s all too familiar in the doctor’s office these days, this bodes well.

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