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New Year's resolution for healthcare: Bring physician assistants to the table

January 14th, 2016

by Dawn Morton-Rias

Remember when you were a child and every holiday, your dinner place was reserved at the kids’ table? Then one glorious year you were invited to sit with the adults, signaling that you had passed a significant milestone.

All too often physician assistants (PAs) feel like the kids on the healthcare team. Yes, we are a young profession, not quite 50 years old, compared to medicine and nursing, which have both been around since well before the 19th century. But what I am talking about is a subtle and frequent exclusion of more than 108,500 certified PAs from leadership positions, news coverage and substantive discussions on healthcare.

Due to Medicaid expansion, the increased numbers of patients insured under the Affordable Care Act, and both a shortage and maldistribution of physicians, team-based care is now the de facto standard of healthcare delivery, with each member fulfilling an important role. The ACA specifically authorizes three providers to deliver primary care: physicians, PAs and nurse practitioners.

Yet healthcare headlines often overlook PAs, strategic councils rarely include them and leadership positions in healthcare systems often elude them.

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Part of the problem may be our title. We are not assistants. Yes, we work in collaboration with physicians, but we work autonomously without a physician looking over our shoulders. Within a defined scope of practice based on our education and experience, we take medical histories, diagnose illness, prescribe medication, order and interpret tests and perform intricate procedures. We practice medicine.

However, quantitative studies about PA outcomes are few because insurers usually accumulate data under a physician’s provider number, making it difficult to tie results directly to the PA. We welcome a process that will measure and quantify the valuable work certified PAs do. We deserve the opportunity to have our contributions to the well-being of America validated.

The Centers for Medicaid & Medicare Services (CMS) is doing the fiscally responsible thing by trying to tie reimbursement to the patients’ perspective of care received through programs like the Hospital Consumer Assessment of Health Care Providers and Systems (HCAHPS) survey, delivered to patients after discharge. The goal of providing the highest levels of patient satisfaction is a noble one. Additionally, high scores on these surveys now result in incentive payments for hospitals and health systems. It is a cornerstone of value-based care.

However, PAs are invisible providers in the HCAHPS survey, which asks only about treatment received from physicians and nurses. Yet PAs work throughout hospitals. More than 20 percent of certified PAs nationally work in surgery and surgical subspecialties, almost 14 percent work in emergency rooms, and another 3 percent work as hospitalists, caring for patients from admission through discharge. Still others work in critical care, anesthesiology, obstetrics and internal medicine.

With such a broad ranges of capabilities, why aren’t certified PAs considered for strategic positions in healthcare? Look at the leadership teams of major healthcare systems and you find MBAs, physicians, nurses, social workers and others. But where is the diverse perspective PAs bring? After all, these are providers who are:

• Taught like physicians in the medical model but unlike physicians have “grown up” in team care
• Educated and certified as generalists, so they understand medical workflows and the care continuum
• Flexible, willing and able to work in the ER today, a rural health center tomorrow or even make home visits to improve patient compliance and reduce relapses

A 2014 survey of physicians in five specialties in 15 cities by the healthcare consulting firm Merritt Hawkins found that fewer than 50 percent of physicians accepted new Medicaid patients. Additionally, fewer physicians are accepting new Medicare patients.

Who will treat these populations that need it most? Certified PAs are available to give patients care, relief, and education to improve their health and their lives.

Finally, not only are PAs an effective solution to healthcare needs, PAs are the cost-effective solution, as well. For example, the annual salary of a PA in family medicine averages about $90,000, whereas a family practice physician averages $195,000. PAs in surgical subspecialties average about $108,000, versus a cardiovascular surgeon who averages $376,000 or an orthopaedic surgeon who averages $421,000. Using PAs to the full extent of their license and capabilities makes sense for the healthcare system, for the practice and for the patient.

Leaders in business and in healthcare arenas can turn this tide and position the PA profession to achieve the acceptance, respect and influence it deserves. So for 2016, invite a PA to the tables where you are discussing the current and future state of health and healthcare.

Dawn Morton-Rias, Ed.D., PA-C, is the president and CEO of the National Commission on Certification of Physician Assistants.

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