The physician-physician assistant partnership

Why utilizing physician/PA teams improves efficiency, patient satisfaction.

Although physician assistants (PA) are relative newcomers to the healthcare field, they have carved out a niche as one of three primary care providers, along with physicians and advance practice nurses.

Ann Davis, PA-C, senior director of State Advocacy for the AAPA said the physician assistant field is about 45 years old. Graduates of the first PA program out of Duke University were medics who had served in Vietnam.

PA Today
Today, there are 159 accredited PA programs in the country. Davis said the vast majority of practicing physician assistants have a four-year undergraduate degree in one of the sciences followed by 27 months in a PA program, which is split between the classroom and clinical rotations. PA education, she added, is based on the medical school model.

Although the field doesn’t have a long history, Davis said the PA role is quite widely accepted. “Everybody is looking at how we can best coordinate care rather than delivering fragmented or fractured care,” she said, adding physician assistants are well suited for this role and often serve this function on behalf of their patients and supervising physician.

She also noted PAs play an important part in the workforce dynamic, particularly since there are physician shortages in various geographic regions. In some cases, a PA might be the only provider in an underserved area, communicating with a supervising physician via telecommunication.

Davis noted there has been a move in the nation toward preventive, integrated care.

“People want value-based, well-coordinated care. Employers will demand it; patients want it; and certainly if we’re going to contain costs, it’s imperative,” said Davis. “PAs are well known for care coordination. There shouldn’t be an ACO that doesn’t have physician assistants. That would be a big mistake.”

Model of Collaboration
Davis noted a physician-PA team is a great model of collaboration with the physician there to offer decision support. Given a PA’s educational and clinical background, however, collaborating doesn’t mean the physician necessarily has to be at the PA’s elbow, particularly considering the technological advances of telemedicine and distance communication.

In fact, Davis continued, it enhances cost effectiveness and patient satisfaction to have two professionals with some unique and some overlapping skill sets to maximize what each does best. It doesn’t make sense, she said, to have a cardiologist sit down and tell a patient to lower sodium intake and spend 20 minutes on dietary education when another qualified professional is readily available at a more cost efficient reimbursement rate.

“When people choose PA school, they want to be that utility infielder. They want to be that problem solver. They want to look up and down that medical constellation and customize care for the patient,” Davis said.

Maximizing the skills of the PA allows the patient to have the necessary one-on-one time while freeing up the physician to deal with patient problems that require physician-level skills.

“If hospitals and physicians are looking to plan for the future, one of the things they should think of first is how we can maximize PAs in our physician-directed teams,” she continued.

PA Workforce Continues Growing
The Washington, D.C.-based American Academy of Physician Assistants reported in its 2010 Census Report and Salary Report that the number of practicing PA reached 83,466 in 2010, a 100 percent increase over last 10 years. Female PAs outnumber their male counterparts by nearly 20,000. More than 30 percent of PAs practice in primary care, making it the largest specialty for PAs.

Nearly 30 percent of PAs practice in single-specialty physician group practices, and 40-percent have been in their current primary specialty for at least six years. The Census also shows that PAs enjoy their work, as 66 percent indicate they are satisfied or mostly satisfied with their career.

PAs earn a median annual salary of $90,000 according to the Salary report, an increase of 2.8-percent from the 2009 survey.

While the majority of PAs are in clinical practice, an estimated 5,079 PAs work either alone or concurrently   in healthcare education, administration,  research and public health – a figure that demonstrates the growing role PAs play in influencing the entire healthcare field.

by Melanie Wolkoff Wachsman


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