The Patient Protection and Affordable Care Act (PPACA) has been pushing insurers, benefit plan administrators and network managers to find ways to cover about as much medical care as before, in a timely manner, for less.
Carriers promote wellness programs, but wellness programs and self-help websites can do only so much for a nagging cough that won’t go away, and a self-help website can’t (yet) give a patient a checkup.
What’s a plan designer to do?
Some policymakers, and many groups for non-physician care providers, have been encouraging plans, hospitals and physicians to make more use of non-physician providers: midwives, nurse practitioners, and other professionals who earn much less than physicians and are about as well-equipped to give a routine checkup or look at a sore throat.
Some of the non-physician providers who are seeking a higher profile are physician assistants. A physician assistant can’t without physician supervision, or perform surgery unassisted, but a physician assistant can take a patient’s medical history, conduct physical exams, diagnose and treat illnesses, order and interpret tests, make rounds in hospitals and nursing homes, and, in many states, write prescriptions.
Medical doctors usually need a four-year bachelor’s degree, a four-year medical degree, and three to seven years of residency training, for a total of 11 to 15 years of training and residency time.
To start practicing, a physician assistant typically needs a four-year bachelor’s degree, a little more than two years of physician assistant training, and one year of clinical training, for a total of about seven years of training time.
Some have suggested that making too much use of non-physician providers could hurt patient care, by weakening the relationship between primary care physicians and their patients, but physicians themselves have been eager to expand capacity by hiring physician assistants.
The group that certifies U.S. physician assistants, the National Commission on Certification of Physician Assistants (NCCPA), has just put out a collection of data on the physician assistants it has certified, where they work, what they are look, and how much they earn.
For a look at some data from the report, and some thoughts from Dawn Morton-Rias, the president of NCCPA, read on.
1. Physician assistants aren’t necessarily all flooding into primary care.
Many are in family medicine, general practice, internal medicine general practice, or pediatrics, but that’s only about 30 percent of the total. The rest work in areas such as dermatology, hospital medicine and general surgery.
The percentage in primary care ranges from 14 percent in Ohio to 54 percent in Alaska.
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2. Physician varies widely from state to state.
The number of physician assistants per 100,000 residents ranged from fewer than 25 in several states in the West and Deep South, to more than 45 in a number of Northeastern and North Central states.
Alaska ranks first, with about 69 physician assistants per 100,000 residents, and Mississippi ranks last, with just 4.8 physician assistants per 100,000 residents.
3. Physician assistants would like entries of their own in provider directories.
Kaiser, for example, lists physician assistants along with other non-physician providers, such as certified nurse midwives, in its directories.
Many other carriers list only physicians, or only physicians and certain types of non-physician providers, such as chiropractors.
The plans may hint at access to physician assistants by listing the kinds of facilities, such as urgent care facilities, often staffed by physician assistants.
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Morton-Rias sees the lack of attention given to physician assistants slowing efforts to analyze physician assistants’ impact on health care system efficiency.
“There is a data deficit,” she said.
But Morton-Rias said moves by carriers like Kaiser to include physician assistants in their directories are helping to increase awareness of their role in the health care system.