DOCSLIB.ORG

Provider Scope of Practice: Expanding Non-Physician Providers’ Responsibilities Can Benefit Consumers

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Provider Scope of Practice: Expanding Non-Physician Providers’ Responsibilities Can Benefit Consumers RESEARCH BRIEF NO. 21 | NOVEMBER 2017 Provider Scope of Practice: Expanding Non-Physician Providers’ Responsibilities Can Benefit Consumers cope of practice regulations originated as a means the medical, dental and behavioral health spectrum are Sto protect the public from healthcare practitioners trained to perform tasks that can improve healthcare administering care they were unqualified to provide, due value and lower costs. These providers include physician to differences in training. Emerging emphasis on patient- assistants (PAs), dental therapists, dental hygienists and centered care where nurses, physicians, and other members advanced practice registered nurses (APRNs)—a term that of the care team practice to the fullest extent of their includes certified registered nurse anesthetists (CRNAs), training has focused attention on the potential advantages certified nurse midwives, nurse practitioners (NPs) and of expanded scope of practice in overall care delivery.1 clinical nurse specialists. Provider scope of practice regulations define Currently, non-physician providers can face a variety the breadth of services a given type of healthcare of regulatory barriers that may limit their independent professional is permitted to provide based on their level practice authority, prescribing authority and hospital of education, training and experience.2 While physicians attending/admitting privileges. In some states, scope of have traditionally been considered the ‘leaders’ of the practice laws limit the extent to which physicians can healthcare delivery team, non-physician providers across delegate tasks and services to non-physician providers.3 This brief explores how relaxing regulatory barriers facing non-physician practitioners has the potential to SUMMARY significantly increase access to providers, improve quality If state scope of practice laws are overly restrictive, and lower the cost of providing care. they can prevent non-physician providers from Impact on Quality and Access practicing to the fullest extent of their training. Medical associations and physician groups have largely Expanding scope of practice laws can specifically objected to expanded scope of practice due to concerns benefit rural populations and other areas with about quality, particularly stemming from the difference fewer primary care providers and lower access in technical and clinical training between physicians and to primary healthcare services. Evidence suggests other providers. There is no evidence to suggest these that non-physician practitioners have the potential fears are well founded. Recent studies find that there is no to significantly increase provider capacity and statistically significant difference in quality of care between reduce the cost of providing healthcare, with few NPs and PAs when compared to physicians in the primary quality concerns. Moreover, studies show that care setting.4 expanding provider scope of practice can benefit Studies exploring the impact on outcomes are closely consumers in terms of wait times and overall tied to expanded access to services. A study on the access to services. However, more evidence is relationship between scope of practice laws granting needed on if and how savings can be passed independent practice authority to nurse practitioners found a 14 percent reduction in acute care sensitive (ACS) onto consumers. condition emergency department admissions in full- HEALTHCARE VALUE HUB practice authority states two years after practice regulations Non-Physician Providers Acronym were relaxed.5 As high ACS admissions are an indicator of low-quality office-based care, these results would suggest Advance Practice Registered Nurses APRN that expanding scope of practice laws had a positive effect on quality. Nurse Practictioners NP Other evidence includes a study that used the National Certified Registered Nurse Anesthetists CRNA Ambulatory Medical Care Survey’s Community Health Clinical Nurse Specialists CNS Center sample to compare the impact of receiving care delivered by NPs and PAs versus primary care physicians. Certified Nurse Midwives CNM Investigators found that for seven of the nine patient- Physician Assistants PA level outcomes examined, there were no statistically significant differences in NP- or PA-delivered care compared with PCP-delivered care in community health dental therapists appeared to be practicing safely, and centers.6 The bottom line is that physician assistants and clinics where they worked reported improved quality nurse practitioners do not appear to have a detrimental and high patient satisfaction. A similar study using data effect on patient outcomes, and can play a valuable role in from Alaska’s Yukon Kuskokwim Delta community found optimizing the healthcare team by assuming responsibility that increased use of dental therapists were significantly for less-complex patients. associated with higher child and adult preventive Dental hygienists provide preventive and non-surgical care utilization rates and lower rates of extraction periodontal treatments alongside dentists.7 Hygienists are procedures—patterns consistent with improved usually the first point of contact for a patient before seeing outcomes.13 a dentist. A study examining an expanded role for dental Clinical nurse specialists (CNSs) work primarily in hygienists in Oregon found expanded access to oral health inpatient hospital settings, although some also practice services for patients and improved outcomes, particularly in nursing homes, clinics and other community-based among children. The evaluation focused on the state’s settings like home care.14 They can provide value by Expanded Practice Dental Hygienists, who are permitted assisting with the development of facility quality controls, to provide care to limited access populations without the serving as case managers and delivering primary care. 8 permission of a dentist. Unfortunately, there are few studies that have focused Dental therapists are an emerging oral health provider specifically on the quality of care provided by clinical nurse trained to provide preventive and restorative dental care. midwives (CNMs) or clinical nurse specialists. Dental therapist licensure requires an additional two Restrictive scope of practice rules can impede 9 years of education compared to dental hygienists. Alaska evaluations of quality for non-physician providers. When and Minnesota were among the first states to begin APRNs and PAs cannot practice independently they bill licensing dental therapists in the U.S. and examining their services under ‘incident to’ provisions, indicating their impact on access and patient experience.10 In 2009, the physician supervision or collaboration. Payers then Minnesota passed legislation authorizing two types of reimburse at 100 percent of the physician fee schedule and dental therapists: a traditional dental therapist and an the quality of patient care is attributed to that physician.15 advanced dental therapist with two additional years of Essentially, non-physician providers cannot be adequately training and a year of direct, on-site supervised practice.11 evaluated on care quality metrics when not all services the By 2014, the Minnesota Department of Health observed provide are billed under their name. Increasing instances that patients experienced shorter travel and wait times of independent non-physician billing will yield more for dental appointments and expanded capacity at dental informative quality metrics. clinics serving vulnerable populations.12 They also found RESEARCH BRIEF NO. 21 | November 2017 PAGE 2 HEALTHCARE VALUE HUB Impact on Costs physician), some states restrict admitting privileges.23 This results in CNMs being used mainly as a “physician The available evidence on non-physician providers extender,” a role that does not necessarily cut costs since suggest that expanding scope of practice will lower their services would be charged as an additional physician healthcare costs. For example, Medicare and most visit.24 Studies have shown that midwifery care can result private insurers reimburse nurse practitioners (which in lower charges to patients due to their tendencies to 16 comprise 60% of the U.S. APRN workforce ) and order fewer tests; their patients also are less likely to have physician assistants at 85 percent of the physician fee costly Caesarean deliveries.25 schedule when they bill independently and not under physician supervision.17,18 Lower reimbursement Strong evidence suggests that non-physician suggests that hospitals and medical groups can increase cost-effectiveness by employing these non-physician practioners have the potential to significantly providers independently. However, evidence that these increase provider capacity and reduce the cost of savings are passed on to consumers is weak. providing healthcare, with few quality concerns. While nurse practitioners and physician assistants practice within multiple settings and populations, certified registered nurse anesthetists (CRNAs) are Dental hygienists’ prescriptive authority and ability to primarily trained to provide anesthesia services. In initiate treatment without requiring the specific consent fact, they provide the majority of these services in rural of a dentist comprise the central issues pertaining to and underserved urban communities where physician their scope of practice.26 Because reimbursement for 19 anesthesiologists are rare. A 2016 Lewin Group dental procedures varies across government and private study commissioned
Load more

Recommended publications
  • Pre-Health Profession Program
    Pre-Health Profession Program Physician Assistant (PA) Graduate Program Admissions Physician Assistants (PAs) are highly trained health care professionals who practice medicine under the supervision of a physician as part of a health care team. Physician assistants practice in a wide variety of medical and surgical specialties and in a diversity of settings. The scope of a PA’s practice is reflective of their education and experience, in accordance with state laws and regulations. A graduate degree, usually at the master’s degree level, is required to become a physician assistant. Physician Assistants can become nationally certified by taking the Physician Assistant National Certifying Exam (PANCE), that is administered by the National Commission on Certification of Physician Assistants (NCCPA). PAs must also pass a state licensure exam in order to practice and must recertify every 10 years as well as complete 100 hours of continuing medical education every two years. Admission to most Physician Assistant graduate program requires the following: Bachelors degree from an accredited College/University Appropriate pre-requisite coursework Shadowing &/or patient contact experience Minimum GPA 3.0-3.5 (accepted students usually have higher GPAs) Satisfactory GRE scores (acceptable scores vary by institution) Personal Statement College academic transcripts Recommendations (physician/PA, professor, medical or academic). Application for PA programs is primarily through a centralized application service – CASPA (Centralized Application Service
    [Show full text]
  • Establishing a Framework for a Physician Assistant Research Agenda
    Establishing a Framework for a Physician Assistant Research Agenda A Summary of the March 2010 Research Summit Adrianne Wyatt and Christal Ramos, Rapporteurs AMERICAN ACADEMY OF PHYSICIAN ASSISTANTS Alexandria, VA 1 On March 4-5, 2010, the American Academy of Physician Assistants sponsored a two- day PA Research Summit to begin the process of developing a framework for PA- related research. The summit brought together practicing PAs; representatives from the PA academic and regulatory communities; PAs engaged in research; health services researchers; health economists; and thought-leaders from federal agencies, industry, think tanks and private foundations with a demonstrated commitment to health care delivery and health policy research. This publication summarizes the presentations and discussions that occurred at the summit and offers next steps based on discussion priorities. Introduction In its forty-fifth year, the PA profession is maturing and seeks to solidify and forward a comprehensive research agenda about the profession and the profession‟s impact on health outcomes. Throughout the profession‟s growth, there lacked overarching, strategic research goals. Further, research needs have historically never been clearly defined. Therefore, PA-related research has been conducted unsystematically, generally producing more breadth than depth. In addition, very few existing research studies are generalizable; most have small sample sizes or use highly context-specific variables. Because the PA profession is an established and well-accepted profession, it is necessary to reassess its current research and data-gathering methodology. By ensuring that accurate, usable and useful research information is collected and available, the PA profession further solidifies its place in modern health care.
    [Show full text]
  • Sally Ann Mitchell, Edd, Mmsc
    SALLY ANN MITCHELL 1/18/19 CURRICULUM VITAE Sally Ann Mitchell, EdD, MMSc Department of Anesthesia Indiana University School of Medicine 1130 W Michigan St; Fesler Hall 204 Indianapolis, IN 46202 O:317-274-0280 C:678-358-8138 [email protected] EDUCATION GRADUATE Indiana University, Bloomington, IN MSMS track ND Emory University School of Medicine, Atlanta, GA MMSc August 1999 Johns Hopkins University School of Education, Baltimore, MD EdD May 2016 UNDERGRADUATE Northern Kentucky University, Alexandria, KY General ND Hanover College, Hanover, IN BA Biology May 1995 APPOINTMENTS ACADEMIC Johns Hopkins University School of Education Adjunct Faculty/Instructor August 2016-Pres Master of Education in the Health Professions Program Indiana University School of Medicine Department of Anesthesia Assistant Professor of Clinical Anesthesia January 2017-Pres Director of Educational Quality and Research January 2017-Pres Statewide Assistant Clerkship Director January 2017-Pres Master of Science in Anesthesia Program Assistant Program Director April 2017-Pres NON-ACADEMIC IU Health University Hospital Certified Anesthesiologist Assistant January 2017-Pres Indiana University Health Physicians, Indianapolis, IN LICENSURE AND CERTIFICATION Georgia State Composite Medical Board 003351 August 1999-2017 Anesthesiologist Assistant (Physician Assistant Specialist; PA-S) Medical Licensing Board of Indiana / Professional Licensing Agency 75000008A December 2016-Pres Anesthesiologist Assistant (AA) National Commission for the Certification of Anesthesiologist
    [Show full text]
  • New Jersey Prohibition on Surgical Assistants
    New Jersey Prohibition on Surgical Assistants New Jersey has prohibitions on the practice of surgical assistants (i.e. unlicensed individuals). The New Jersey Professions and Occupations Code in Section 45:9-5.11 states that the practice of medicine includes “surgery.” Section 45:9-212 of the New Jersey Professions and Occupations Code lists professionals who are exempt from the Practice of Medicine law, but surgical assistants are currently not included in this list. In addition, in the Administrative Regulations of the Board of Medical Examiners, Section 13:35-4.1 A(2)3 states: “(b) A major surgical procedure shall be performed by a duly qualified surgeon, duly qualified assisting physician who may be a duly qualified surgical resident in a training program approved by the Educational Council of the American Medical Association of the American Osteopathic Association, except in matters of dire emergency. (c) In addition to those individuals listed in (b) above who may act as qualified first assistants, in a health care facility licensed by the Department of Health and Senior Services, a duly qualified registered nurse first assistant (RNFA), a duly qualified physician assistant or a licensed podiatric physician may so act. A duly qualified certified nurse midwife (CNM) may also act as a qualified first assistant in the performance of cesarean sections.” Taking the above laws into consideration might lead to a conclusion that surgical technologists might not be able to first assist in New Jersey, although in cases of minor surgery this might be allowed. Physician Assistants and Registered Nurse First Assistants approached the New Jersey Board of Medicine in 1995 in order to get an opinion rendered that would allow them to first assist.
    [Show full text]
  • Words Underlined Are Additions. Hb0607-01-C1 FLORIDA HOUSE of REP RESENTATIVE S
    FLORIDA HOUSE OF REP RESENTATIVE S CS/HB 607 2020 1 A bill to be entitled 2 An act relating to health care practitioners; amending 3 s. 456.0391, F.S.; requiring an autonomous physician 4 assistant to submit certain information to the 5 Department of Health; requiring the department to send 6 a notice to autonomous physician assistants regarding 7 the required information; requiring autonomous 8 physician assistants who have submitted required 9 information to update such information in writing; 10 providing penalties; amending s. 456.041, F.S.; 11 requiring the department to provide a practitioner 12 profile for an autonomous physician assistant; 13 amending ss. 458.347 and 459.022, F.S.; defining the 14 term "autonomous physician assistant"; authorizing 15 third-party payors to reimburse employers for services 16 provided by autonomous physician assistants; deleting 17 a requirement that a physician assistant must inform a 18 patient of a right to see a physician before 19 prescribing or dispensing a prescription; revising the 20 requirements for physician assistant education and 21 training programs; authorizing the Board of Medicine 22 to impose certain penalties upon an autonomous 23 physician assistant; requiring the board to register a 24 physician assistant as an autonomous physician 25 assistant if the applicant meets certain criteria; Page 1 of 152 CODING: Words stricken are deletions; words underlined are additions. hb0607-01-c1 FLORIDA HOUSE OF REP RESENTATIVE S CS/HB 607 2020 26 providing requirements; providing exceptions;
    [Show full text]
  • The Productivity Potential of the Physician Assistant Author(S): Richard Zeckhauser and Michael Eliastam Source: the Journal of Human Resources, Vol
    The Productivity Potential of the Physician Assistant Author(s): Richard Zeckhauser and Michael Eliastam Source: The Journal of Human Resources, Vol. 9, No. 1 (Winter, 1974), pp. 95-116 Published by: University of Wisconsin Press Stable URL: https://www.jstor.org/stable/145047 Accessed: 27-05-2020 21:46 UTC JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected]. Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at https://about.jstor.org/terms University of Wisconsin Press is collaborating with JSTOR to digitize, preserve and extend access to The Journal of Human Resources This content downloaded from 206.253.207.235 on Wed, 27 May 2020 21:46:22 UTC All use subject to https://about.jstor.org/terms THE PRODUCTIVITY POTENTIAL OF THE PHYSICIAN ASSISTANT* RICHARD ZECKHAUSER MICHAEL ELIASTAM, M.D. ABSTRACT The physician assistant is a title applied to individuals who assume at least a portion of physicians' traditional duties. This paper develops a produc- tion function methodology to estimate the potential contribution of physician assistants in the delivery of medical care. This methodology is applied to a paradigm delivery mode, an urban health center. Following upon a discussion of the possibilities for delegation and the efficient assignment of medical tasks to physician assistants, a numerical production function is estimated for physicians and physician assistants working together.
    [Show full text]
  • AAFP and Azafp Joint Letter Opposing Arizona HB 2419
    February 12, 2020 The Honorable Nancy Barto The Honorable Jay Lawrence Chair Vice-Chair House Health & Human Services House Health & Human Services Committee Committee 1700 W. Washington Street 1700 W. Washington Street Phoenix, AZ 85007 Phoenix, AZ 85007 Dear Members of the Arizona House Health & Human Services Committee: On behalf of the American Academy of Family Physicians (AAFP), which represents 134,600 family physicians and medical students across the country, and the Arizona Academy of Family Physicians (AzAFP), which represents 2,200 family physicians and medical students in Arizona, I write to share our strong opposition to H.B. 2419. This legislation would create a new licensure category of “assistant physician” for medical and osteopathic school graduates who have not attended or completed an accredited residency program to practice medicine. Simply put, allowing unqualified medical school graduates to practice medicine without the necessary training acquired in residency is dangerous to patient health and safety. Arizona should not create special licensure pathways for those who have not completed a residency program. Assistant physician refers to medical school graduates who have neither matched with nor completed a residency program. While these individuals successfully completed four years of rigorous medical school instruction, these graduates lack the meaningful direct patient care experience and education achieved during residency training –an additional 12,000 to 16,000 hours of clinical patient care beyond medical school – that is critical to provide quality and comprehensive primary care to patients. The AAFP and AzAFP supports the practical training provided by an accredited family medicine or other primary care residency as it provides hands on practice and guidance in the realities of delivering independent high-quality patient care.
    [Show full text]
  • House Bill No. 2275
    SECOND REGULAR SESSION HOUSE BILL NO. 2275 98TH GENERAL ASSEMBLY INTRODUCED BY REPRESENTATIVE FREDERICK. 5207H.02I D. ADAM CRUMBLISS, Chief Clerk AN ACT To repeal sections 334.037, 334.104, and 334.735, RSMo, and to enact in lieu thereof three new sections relating to physician supervision. Be it enacted by the General Assembly of the state of Missouri, as follows: Section A. Sections 334.037, 334.104, and 334.735, RSMo, are repealed and three new 2 sections enacted in lieu thereof, to be known as sections 334.037, 334.104, and 334.735, to read 3 as follows: 334.037. 1. A physician may enter into collaborative practice arrangements with 2 assistant physicians. Collaborative practice arrangements shall be in the form of written 3 agreements, jointly agreed-upon protocols, or standing orders for the delivery of health care 4 services. Collaborative practice arrangements, which shall be in writing, may delegate to an 5 assistant physician the authority to administer or dispense drugs and provide treatment as long 6 as the delivery of such health care services is within the scope of practice of the assistant 7 physician and is consistent with that assistant physician's skill, training, and competence and the 8 skill and training of the collaborating physician. 9 2. The written collaborative practice arrangement shall contain at least the following 10 provisions: 11 (1) Complete names, home and business addresses, zip codes, and telephone numbers 12 of the collaborating physician and the assistant physician; 13 (2) A list of all other offices or locations besides those listed in subdivision (1) of this 14 subsection where the collaborating physician authorized the assistant physician to prescribe; 15 (3) A requirement that there shall be posted at every office where the assistant physician 16 is authorized to prescribe, in collaboration with a physician, a prominently displayed disclosure EXPLANATION — Matter enclosed in bold-faced brackets [thus] in the above bill is not enacted and is intended to be omitted from the law.
    [Show full text]
  • Mission, Vision and Guiding Principles
    MISSION, VISION AND GUIDING PRINCIPLES MISSION STATEMENT: The mission of the University of Wisconsin-Madison Physician Assistant Program is to educate primary health care professionals committed to the delivery of comprehensive, preventative and therapeutic health care in a culturally and ethnically sensitive manner, with an emphasis on primary health care for populations and regions in need. VISION STATEMENT: The Physician Assistant Program will prepare and educate physician assistants to provide comprehensive quality health care to all. In addition, the program will serve as an academic and professional leader in the physician assistant profession by contributing its strengths in education, distance education, technology, community-based training and grant initiatives. GUIDING PRINCIPLES: To hold an attitude of high respect for self and others, and to acknowledge and value the talents and skills of each individual To demonstrate a genuine commitment and dedication to improving the health and welfare of patients and respect individual patient circumstances and wishes throughout life and death To strive for excellence in all we do To maximize resources and through continued, life-long learning and critical-thinking, continue to advance knowledge and skills that will lead to the well-being of all persons To demonstrate personal integrity and ethical conduct To foster and model professionalism To embrace individual differences and to enhance cultural awareness To instill the value of leadership, particularly as it relates to meeting healthcare
    [Show full text]
  • “ Compendium of Graduate Medical Education Initiatives”
    AMERICAN MEDICAL ASSOCIATION “ Compendium of graduate medical education initiatives” Table of contents Introduction . 1 Background . .1 Why reform GME? . 1 Current GME initiatives . .. 2 Federal legislation for GME expansion . 2 Institute of Medicine (IOM) . 3 American Medical Association . 4 Council on Graduate Medical Education (COGME) . .. 4 Association of American Medical Colleges (AAMC) . 5 American Academy of Family Physicians (AAFP) . .. 5 Heritage Foundation . .. 5 Program on Health Workforce Research and Policy at the . 5 Cecil G . Sheps Center for Health Services Research State initiatives . 6 Regional medical education: The WWAMI experiment . 6 International medical graduates . 6 Proposals for GME reform . 7 Part A: Considerations for GME reform . 7 Percentage of reimbursements and/or insurance plans . 7 for GME funding All-payer model . 7 Payments tied to quality measures or performance metrics . 8 “Grown Your Own” approach of Kaiser Permanente . .8 Teaching Health Center (THC) and Primary Care . .9 Residency Expansion (PCRE) Grants Governance board to decide needs . 9 Combine IME with DGME . 10 Per resident payment amount . 10 Tax breaks for hospitals that privately fund residency positions . 10 “Bed-tax”: A State provider tax/assessment/fee . 11 Increasing grant money to GME training . 11 Part B: Alternative routes for medical students who fail to match . 11 Assistant physicians . 11 Program-specific “5th year” or research + clinical programs . 12 for unmatched graduates American Medical Association “Compendium of graduate medical education initiatives” report ii Table of contents (continued) Master’s programs for non-matched medical students . 12 Increase number of “transitional years,” “traditional rotating . 12 internships” and “intern years” Appendix A: The IOM Report .
    [Show full text]
  • VAPA Position Paper--Assistant Physician Smooth Draft
    VAPA Position Paper Standardization of Licensure Requirements for Health Professionals to Assure Public Protection and Transparency On 10 July 2014 Missouri's Governor signed into law authorization for the Missouri Board of Healing Arts to license medical school graduates who have completed Steps 1 and 2 of the United States Medical Licensing Exam (USMLE) as "assistant physicians" and to promulgate rules pertaining thereto. This act allows certain medical school graduates who have passed Steps 1 and 2 of the USMLE but not yet successfully passed USMLE Step 3, to obtain an assistant physician license in order to enter into an "assistant physician collaborative practice arrangement" with a licensed physician. The arrangement is designed to meet care gaps and provider shortages in rural and underserved areas. As a Constituent Organization, VAPA adheres to AAPA's Guidelines for the Ethical Conduct for the PA Profession, which dictates that "Physician Assistants hold as their primary responsibility the health, safety, welfare, and dignity of all human beings." Creating new professional categories to satisfy the needs of a few is in opposition of standardized licensure that serves to protect the general public, and limits the transparency that patients deserve. These providers would be allowed to identify themselves as doctors, not requiring clarification of the position for which they hold a license. Those who do identify as Assistant Physician would potentially provide misperception of their provider role. On 30 September 2014, leadership from the Virginia Academy of Physician Assistants and other stakeholders from throughout the Commonwealth of Virginia attended an ad hoc workgroup to evaluate the efficacy of similar legislation.
    [Show full text]
  • The Evolutionary Role of Physician Assistants Across the United States, Canada, and the United Kingdom
    Invited Editorial The Evolutionary Role Of Physician Assistants Across The United States, Canada, And The United Kingdom BRAYDEN GERRIE* AND ELIZABETH A. HOLBROOK‡ Department of Health and Human Performance, Roanoke College, Salem, VA, USA *Denotes undergraduate student author, ‡Denotes professional author ABSTRACT International Journal of Exercise Science 6(1) : 1-8, 2013. With physician shortages looming ominously on the horizon, healthcare systems across the globe are awaiting a surge of eager young doctors to enter the field. Much to the dismay of these systems, it does not appear that there will be a collective sigh of relief in the coming years. Fortunately there still remains a promising position to fill the gaps and potentially overcome the growing inundation of patients, shortage of general practice physicians, and ever growing underserved rural populations: the position of physician assistant (PA). Through this review, the evolution of the PA position will be discussed from the perspective of healthcare systems in the United States, Canada, and the United Kingdom. Further, an outline of the educational requirements, projected student debt-to- income ratios, and position availability will be touched upon. KEY WORDS: Medical assistant, physician extender, doctor shortage, underserved BACKGROUND depth knowledge required by NP’s in more specialized settings minimizes their ability A physician assistant (PA) has been to provide the same breadth of services described uniformly across Canada, the offered by a PA, this level of specialization United States (US) and the United Kingdom allows the NP to practice independently (UK) as a licensed health professional who (19). Conversely, should a PA choose to is trained using the medical model in order enter the realm of specialty medicine, the to perform an extensive range of both skills they acquired through PA school diagnostic and therapeutic services under serve as a foundation for extensive on-the- the supervision of physicians (18).
    [Show full text]