Montana Suggests Amendment Qualifying Physician Assistants to Serve as Mental Health Professionals

Montana lawmakers will soon decide if physician assistants should gain legal status as mental health professionals. Right now, the only occupations listed being able to assume the role of mental health professional under state law include:

  • Advanced Practice Registered Nurses
  • Physicians
  • Licensed Counselors
  • Psychologists
  • Social Workers

In mid-January, Rep. Kelly McCarthy (D-Billings) proposed House Bill 220, which would allow physician assistants with a clinical specialty in psychiatric mental health to likewise serve as mental health professionals.

The amendment was co-written by local physician assistant Kaitlin Staebler. According to the Billings Gazette, Staebler realized the need to expand physician assistants’ scope of practice to include more extensive mental health services while completing her school rotations.

Staebler claims the amendment would lessen the mental health professional shortage as well as the alarmingly high suicide rate in Montana.

In fact, suicide is a major public health trouble throughout the state. The Department of Public Health & Human Services (DPHHS) reported that Montana held “the highest rate of suicide in the United States” in 2014.

One of the many recommendations suggested by the DPHHS to prevent suicide includes state legislature intervention that would require primary care providers, such as physician assistants, to receive training in suicide prevention and risk assessment.

Right now, in emergency situations, current legislation prohibits physician assistants practicing in mental health to order 24-hour psychiatric holds or employ chemical and physical restraints because they are not officially considered mental health professionals.

In the end, McCarthy and Staebler simply want patients to have greater access to mental health services. And giving physician assistants the same legal rights as mental health professionals does just that, and at no cost.

The passing of House Bill 220 will depend on the approval of both the House and Senate.

Physician Assistants Enter More Specialty Fields as the Doctor Shortage Worsens

The annual summary of the PA profession by the National Commission on Certification of Physician Assistants (NCCPA) revealed a new trend in the workforce.

While PAs are often considered providers for primary care, large numbers of them are moving into specialty fields such as emergency medicine and surgery. In fact, more than 70% of PAs now work in areas other than primary care.

Dawn Morton-Rias, an NP and Chief Executive of the NCCPA, told Forbes that a key reason for the growth of PAs working in specialties such as emergency medicine and surgery is often the result of shortages of physicians in those areas.

The Association of American Medical Colleges projected a shortage of at least 61,000 physicians by 2025. A number of states are responding to this critical shortage by providing greater autonomy to PAs.

Part of the reason for this shortage is the influx of millions of new patients who gained insurance coverage under the ACA. Also, PAs increased their lobbying efforts to get more direct access to patients by changing scope-of-practice laws at the state level.

For instance, New Jersey eliminated the countersignature requirement earlier this year, joining nearly 30 other states that have done so. In addition, its legislature removed an onerous rule that required PAs who work in a hospital or other inpatient setting to have “continuing or intermittent presence” with a collaborating physician.

PAs are becoming an integral part of accountable care organizations (ACOs) and other patient-centered medical care entities that contract with Medicare and Medicaid programs and insurers. Insurers such as Blue Cross and Blue Shield, UnitedHealthGroup, Anthem, and Aetna increasingly sign contracts with ACOs. This trend accompanies the shift away from fee-for-service medicine.

Morton-Rias stated that PAs provide high quality care at a lower cost that that of physicians. While PAs in some specialties earn between $100,000 and $120,000, the salary for PCPs surpassed $250,000 in 2016.

Research Finds that Expanding PA Staffing at Hospitals is Correlated with Lower Cost of Care and Similar Patient Outcomes

A recent study published in the Journal of Clinical Outcomes Management adds to the body of knowledge suggesting that physician assistants offer high quality care at a lower cost than physicians.

Researchers examined data from a community hospital in Maryland between January 2012 and June 2013. The 384-bed hospital had two staffing groups. One was “conventional” with nine physicians and two physician assistants. The other expanded its PA staff, so that it had three physicians and three physician assistants.

The hospital employed the group comprised primarily of physicians while the expanded PA group were part of a contracted hospitalist group (Physicians Inpatient Care Specialists).

The study encompassed more than 90% of inpatients receiving internal medical treatment. The researchers compared a number of factors between the two groups comprised of nearly 17,000 adult patents:

  • In-hospital mortality
  • Length of stay
  • Readmission
  • Cost of care
  • Consultant use

While cost of care was lower in the group with a larger number of PAs, the other factors remained the same.

The data on the difference in the cost of care was highly significant and had a probability factor indicating that the likelihood of this difference being due to chance was less than 0.1%. The analysis of the other factors indicated that they met the gold standard of 95% probability.

To the researchers’ knowledge, this study was the first to compare care provided by hospitalist groups comprised of expanded PAs versus a hospitalist group with a greater proportion of attending physicians during the same time at the same hospital.

The researchers concluded that expanding the role of PAs provides a cost-effective way to obtain a similar level of care.

Salary Data from the AAPA Shows Continued Growth in Demand and Compensation for Physician Assistants

With a number of studies showing that PAs provide high quality, cost effective care, it makes sense that demand for these professionals has been consistently increasing in recent years. The American Academy of PAs (AAPA) recently quantified both the increase in demand for these advanced nurses and that of their salaries.

A press release from the AAPA released in late September 2016 provided this good news for physician assistants. The organization’s rigorous analysis of salaries from nearly 16,000 survey respondents provides very strong data to buttress these conclusions.

The median base salary for physician assistants increased by 3.4% between 2014 and 2015 alone. In addition, salaries increased about 50% greater than the rate of inflation between 2000 and 2015.

This new report also describes rapid growth in the number of PAs:

  • The profession doubled in size during every decade since 1980
  • The number of PAs increased by more than one third between 2010 and 2015

Despite this sizable increase in the number of PAs, demand remains high for these professionals. The AAPA CEO, Jennifer L. Dorn, described several reasons for the continued demand for physician assistants:

  • PAs are “taking on new leadership roles in health systems”
  • They are well positioned to respond to the growing and aging population in the US
  • The shift towards value-based care benefits PAs as does the “renewed focus on patient education and prevention”

The large number of survey respondents ensured that the analyses are highly statistically significant with a margin of error of +/- 72%. Additionally, the data met the gold standard of being significant at a 95% confidence level. Details of this new study can be found at https://www.aapa.org/salaryreport.

Stanford University to Replace Associate Degree with Master Degree Option for Physician Assistants

U.S. News & World Report recently ranked Stanford University the #2 “Best Medical School” in 2017, and it continues to earn its reputation as a worldwide leader in education by consistently designing programs that directly benefit the changing needs of the medical community.

Last month, on September 15, the school excitedly announced plans to open a new master of science program for physician assistants. Set to begin in fall 2017, the graduate program will replace the school’s diminishing associate degree program that began training physician assistants as far back as 1971. Once the students currently enrolled in the associate program graduate, the degree option will cease altogether.

According to staff members employed at Sanford, the university’s decision to offer the upcoming M.S. in PA Studies degree option was the logical response to shifting dynamics within the medical field. Today, physician assistants’ must assume greater professional responsibility due to several emerging factors, including:

  • Broadening public access to healthcare
  • Growing demand for more complex medical care
  • Expansion of physician assistants’ scope of practice
  • Continual shortage of physicians nationwide

The master’s program is structured to accommodate between 25 and 30 PA students over a 30-month period, during which time students will spend five quarters focusing on foundational sciences training followed by a one-year clerkship. Those enrolled in the program can chose from four areas of concentration:

  • Health services and policy research
  • Medical education
  • Community health
  • Clinical research

Clinical clerkship opportunities will be offered in:

  • Ambulatory family medicine
  • Pediatric
  • Emergency medicine
  • Obstetrics and gynecology
  • Psychiatry
  • Internal medicine
  • Surgery

Of course, competition to gain entrance into the program will undoubtedly be fierce. The Admissions Committee will weigh these six major factors during the student acceptance process:

  • Academic (GPA, GRE): 40%
  • Health care experience and scholarly output: 20%
  • Leadership potential: 10%
  • Interpersonal communication skills: 10%
  • Supporting materials: 10%
  • Community service: 10%

Controversy Surrounds Tuition for New Physician Assistant Program in Florida

Researchers speculate that Florida will continue to struggle against a statewide physician shortage, which has educators and politicians alike scrambling to offer up viable solutions.

According to the Robert Graham Center, Florida will need 38% or 4,671 more primary care physicians from 2010 to 2030 in order to meet the demands of an aging and expanding insured population.

But how will the state produce such a large number of future physicians?

On April 15, Florida’s Gov. Rick Scott approved a bill giving physician assistants the limited authority to write prescriptions for patients. This landmark decision could be the first step towards giving physician assistants a much greater scope of practice. By doing so, the state could potentially ease the physician shortage while simultaneously becoming more dependent on physician assistants.

Anticipating this growing dependency, the Florida Gulf Coast University (FGCU) began developing a physician assistant master’s degree program in 2012. After finally gaining approval from the school board to open the program in 2017, the FGCU began investing tens of thousands of dollars into covering program costs for the accrediting commission, consultants, and new hires.

To cover program expenses, the FGCU settled on a $667 tuition fee for students. Yet, on July 1 a new law took effect that vanquished the university board’s ability to determine its own tuition rates. That power now lies in the hands on the Board of Governors, which may threaten the program’s very existence.

The Board of Governors fails to understand the need for another physician assistant program, explaining that other state universities already offer similar programs. And even if the FGCU’s program is green-lighted, the school will still have to convince the Board of Governors to authorize its tuition proposal.

Although the fate of the program remains uncertain, it appears certain that the ongoing debate over it will continue to create tension before the two boards until both sides arrive at a mutually beneficial compromise.

Former PA Pushes For Medical Reform in Her Role as a California Congresswoman

Lobbyist’s fight long and hard to sway members of Congress to their causes, hoping to find an advocate for their particular legislative woes. So, physician assistants should be pleased to know that, without any lobbying at all, they have their very own advocate in Congress.

A former PA, Representative Karen Bass of California, recently pushed for legislation to make sure that students hoping to become physician assistants have access to the educational resources they need to succeed.

“PAs across the nation are providing high quality healthcare to patients in bout our largest cities and in America’s most rural areas,” said Rep. Bass, “In the next decade the demand for PAs is only going to increase and Congress needs to act today to make sure that we have the qualified health care professionals ready to meet the growing need.”

Bass introduced two bills that could have a huge impact on the role that physician assistants play in healthcare. The first of these is H.R. 3943. This measure would expand scholarship opportunities for PAs in several different ways. First, it offers scholarships and loan repayment for students who are willing to return and teach PA students. It also offers scholarships and repayment for PAs who choose to work in areas without appropriate medical care or in community health centers.

The second is H.R. 3944. This works alongside 3943 to improve the quality of PA programs overall and to increase grants for Historically Black Colleges and Universities to develop and improve PA programs.

While these bills are still in the midst of the legislative process, they have the potential to radically change the role that PAs have to play in the face of increasing shortages in the medical field. Hopefully, Congress will recognize the impact that PAs could make and implement some of the proposals put forth by Representative Bass

Military Roots Provide Opportunity for Veteran PA Students

The very first physician assistants were all active duty members of the military graduating from Duke University in 1965. The program began as a means of quickly training doctors to meet the needs of the growing population after World War II. The University of South Dakota’s current physician assistant program continues to honor this heritage by focusing on the role that the military has to play in its student’s education.

The physician assistant program at USD plays a crucial role in South Dakotan healthcare. The program admits 25 students every year, 20 of which are required to be South Dakota residents. It has graduated 390 students overall, and 175 of those alumni continue to work in South Dakota today. Providing quality healthcare to the many small rural communities in South Dakota is the primary goal of USD’s physician assistant program, and former and current members of the military play an important role in achieving it.

Members of the military regularly receive training that prepares them for a more complex physician assistant program. Alex Sherlock, who served in the Special Warfare Craft Crewman division of the Navy, acted as support personnel for Navy SEALS. His job was to pilot specialized watercraft to retrieve SEAL units from combat zones. At the same time, he was also responsible for transporting medical supplies to remote villages and aiding the physicians tasked with caring for these far off people.

Prior to joining the Navy, Sherlock had graduated from USD with a degree in criminal justice. His medical missions in the navy inspired him to pursue a career as a physician assistant after returning to the U.S. in 2014. Thanks to his time in the military and the credits transferred from his undergraduate degree, Sherlock will graduate in 2016 and be able to start impacting health care the world over.

Someone looking to begin a career as a physician assistant will find that the field’s roots in military service are still an important part of being a physician assistant today.

Duke Celebrates 50 Years of Physician Assistant Programs

50 years ago, Duke University founded the very first Physician Assistant program, forming the base of a medical tradition that is absolutely crucial to the maintenance of health in the modern world. Last week, they celebrated that 50-year heritage, inviting alumni from around the globe to be honored for their contributions to medicine.

The program was established by Dr. Eugene Stead to address a growing shortage of physicians in 1965. By teaching students how to take patient histories and perform basic examinations, physicians were free to focus on other tasks and see more patients. Since its inception, the program has grown to a powerhouse offering a rotation through clinics in five different countries. Its graduates are able to enter into a diverse range of fields, and importantly, it also boasts an almost equal male to female ratio, reflecting changing opinions on women in the workplace over the past half century.

The program’s current director, Karen Hills, believes that it is the Duke’s Physician Assistant’s programs responsibility to stay at the forefront of the field. Physician Assistant’s today are often expected to make independent medical decisions, and that is reflected in an increase in the quality and complexity of Duke’s PA program.

Part of this comes from the unique requirement on Duke PA students that they complete 1,000 hours of clinical healthcare experience prior to entering into the program. Nurses, EMTs, and army medics are just some of the many different medical specialists who would qualify to enter the program. Every classroom is filled with students with diverse medical experiences that adds to the group’s learning process.

Many of the techniques and procedures used at Duke have been emulated with great success in physician assistant programs around the world. PAs everywhere have the honor of celebrating, alongside Duke, their contributions over the past half century to the world of medical science and the countless lives saved as a result.

Proposed Alterations to Physician Payment Sunshine Act Puts Spotlight on Physician Assistants

Over the years, physician assistant’s responsibilities have evolved with the needs of the public. While the same may not have been true a few decades ago, physician assistants today undergo expert training and education and are certified to prescribe certain medications that previously only doctors could.

However, it is not uncommon to see doctors coming under fire for abusing their prescriptive authority by selling their services to pharmaceutical companies. Companies will pay doctors thousands of dollars to prescribe their medicine to patients in lieu of treatments that might have similar results.

In response, the Physician Payment Sunshine Act (PPSA) was established. It requires pharmaceutical companies and medical device manufacturers to disclose payments made to doctors, dentists, chiropractors, and other medical professionals with advanced degrees.

However, the PPSA does not include physician assistants and nurse practitioners, creating a loophole. Physician assistants cannot prescribe many controlled narcotics like doctors, but they are still able to prescribe and recommend a variety of medications and treatments.

Pharmaceutical companies have taken advantage of this. A physician assistant in Rhode Island was sentenced to 6 months in prison after it was revealed that he had taken kickbacks from a medical device manufacturers amounting to $120,000. It is more difficult to identify if a physician assistant is receiving kickbacks from a corporation because corporations are not required by law to report the kickbacks, though the practice is still illegal in and of itself.

Iowa Senator Charles Grassley proposed a bill last Wednesday that would update the PPSA to include physician assistants and nurse practitioners. If the bill passes, it will cause sweeping change in the medical field. It does more than just put added scrutiny on physician assistants. It also shows their importance to the medical process. They play a huge part in helping patients to find the best possible treatment. Doing so ethically, with the patient’s needs at the forefront, is a crucial part of providing the highest quality care.


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