Physicians Find PAs Invaluable, Indispensable

Physician assistants celebrated an anniversary last month. It was 41 years ago—October 6, 1967, to be exact—that the first class of PAs graduated from Duke University in North Carolina. Today, there are 141 PA programs nationally, and more than 68,000 PAs are employed by medical groups, clinics, and hospitals. Great strides and acceptance, right? Well, maybe.

“I think there’s still a lot of old school concepts from physicians that they’re the only ones who can take good care of a patient,” says Mary Mehta, MD, chief of pediatrics at Nemours Children’s Clinic in Pensacola, Fla. Mehta believes that surgeons, in particular, have embraced the use of PAs more than medical physicians because they’ve seen how PAs can assist them in surgery and provide follow-up care while the surgeon moves on to the next patient. But for others, according to Mehta, “I think there’s a big hurdle that a lot of people still need to get over.”

Breaking down walls

Ryan Krasnosky has been a PA with Nemours Children’s Clinic since graduating from the University of Florida 8 years ago. He says that education is the biggest key to overcoming the misconceptions about what PAs are and what their role is in the healthcare delivery process. Those misconceptions, he points out, are held by patients and their families as well as physicians, the latter of which see PAs as competitors trying to take away their patients. Krasnosky says that idea is the farthest thing from the truth.

“We’re there to make their lives easier, allow patient care to run smoother, and enable physicians to see more patients more efficiently,” he says. “I think that some of the medical physicians don’t really know what we do.”

Linda Kientz, a PA working in plastic surgery at Parkland Health and Hospital System in Dallas, believes that some of the confusion surrounding PAs stems from the diversity of the training they receive. “Nurse practitioners already have their title, like family nurse practitioner, or nurse practitioner in pediatrics; they’re labeled already,” says Kientz. “But many of us are trained on the job by our physicians. So, from one PA to the next, we may not be the same as far as our training.”

Valuable team members

Trying to imagine life today without a VCR, a DVD player, or some sort of digital recording device connected to your television set is simply unthinkable. How could you do without it? That’s the same feeling expressed by physicians who have embraced PAs as valuable members of their healthcare delivery team. Jeff Janis, MD, chief of plastic surgery at Parkland Health and Hospital System, says that PAs are absolutely invaluable and indispensable to his practice and his service.

“I use them in the ER, I use them in the clinic, I use them in the OR,” says Janis, explaining that PAs working under his supervision will evaluate a patient and take their medical history, prepare casts or splints following surgery, and help with writing up some of the paperwork. “From an efficiency standpoint, we’re dividing and conquering. From a financial standpoint, it makes absolute sense. Because time is money, and time is my most valuable asset. There’s a difference between working smart and working hard, and [utilizing PAs] is a pure example in my mind of working smart.”

Jim Fenno, MD, emergency room medical director at Sacred Heart Hospital in Eau Claire, Wisc., uses PAs to spearhead the initial workup on some complex medical cases, freeing both him and other physicians to spend time with additional patients. “The PA can take the time to do a real in-depth history and physical, and get some lab tests going,” says Fenno. “That expedites my care. If I was alone, it would be that much longer before I could get in and see the patient.”

Forward thinking

Krasnosky believes that in addition to the cultural and educational changes regarding PAs that need to continue to evolve, so must the insurance reimbursement perspective. He recalls that 8 years ago, the majority of health insurance carriers would not pay for patients to be seen by mid-level providers. Today, those that don’t reimburse for care provided by a PA are in the minority.

Fenno agrees that it’s important to educate patients on the insurance front. “I don’t think [patients] really understand what it means [to see a PA]. What it should mean to them is that they’re going to see a medical provider that much sooner, and sometimes at a lower cost if the physician is not involved. Yet, they’re still going to get that physician oversight to maintain quality of care.”

Janis says the learning curve for a PA is no different than it is for a resident, and he likens PAs to sponges. “There’s an enthusiasm that they have, a zest for their profession,” he explains. “And the whole key is finding the right person for the right job, and that’s no different than any other career in this country. I have four PAs working for me, and I’m hiring two more. And when you find the right person, they pay that back in spades.”

Ed Rabinowitz is a veteran healthcare writer and reporter. He welcomes comments at edwardr@frontiernet.net.