As the country ages and more than 30 million new patients enter the health care system under the Affordable Care Act, experts predict that soon, there won’t be enough doctors for everyone who wants to see one—a shortage of 90,000 doctors by 2020, according to the Association of American Medical Colleges. To meet the demand, a surging class of almost-but-not-quite-doctors known as physician assistants, are stepping up to fill the M.D.’s shoes.
While the physician assistant profession isn’t new—the first ones were trained at Duke University back in 1967—experts say that the doctor shortage, combined with swelling ranks of patients, has made them more vital to the health care system than ever before.
There are now more than 100,000 certified physician assistants in the U.S., up 34% since 2008, and while the employment prospects for most fields remain bleak, the Department of Labor forecasts the number of physician assistant jobs will grow another 30% by 2020. The number of nurse practitioners, which have similar training and duties, is also expected to rise.
Though physician assistants don’t go to medical school, experts say they can fill about 80% of a doctor’s role. They can prescribe medication in all 50 states, run medical practices when the supervising doctor is in another part of the country and even help perform endoscopies and heart procedures.
“Things that doctors used to do are now being done by physician assistants or nurse practitioners,” says Craig Garthwaite, assistant professor at Northwestern University’s Kellogg School of Management and author of the paper “The Doctor Might See You Now: The Supply Side of Public Health Insurance Expansions,” published last month.
They can also see patients more cheaply than doctors can, says James Cawley, who directs George Washington University’s physician assistant master’s program. “Physician assistants usually generate a lot more income for the practice than their salary,” he says. If Medicare reimbursements are any indication, the work of a physician assistant is worth 85% that of a doctor. (Physician practices can bill for the full amount when the doctor is in the office.)
Some patients are understandably wary about receiving care from nondoctors. But just because physician assistants didn’t go to medical school doesn’t mean they can’t take care of you: Educators say the training programs mirror medical school in many ways, and studies have shown that physician assistants provide the same level of care as doctors, with no additional liability or malpractice risk. Many patients don’t even realize that their “doctor” isn’t actually a doctor, but a physician assistant. “Care receivers think everybody is their doc,” says Anthony Brenneman, president of the Physician Assistant Education Association.
But recently, medical societies and insurance companies have raised concerns about how much leeway physician assistants should have to practice medicine—and courts have attempted to draw the line between doctor and physician assistant. Earlier this year, a New Jersey court case revoked physician assistants’ ability to perform needle electromyography tests, a complex diagnostic procedure, ruling that it was beyond the qualifications of the profession. “There is an enormous disparity in licensing requirements between physicians and physician assistants,” attorneys for the American Medical Association wrote in a friend-of-the-court brief supporting the decision.
In general, even physician assistants have an increasing amount of autonomy to care for patients, a doctor is still legally required to supervise: “The physician is still the captain of the ship,” Cawley says.
Several climate changes in the health-care system have contributed to the need for more hands on deck: New regulations limit the number of hours medical residents can work, and declining reimbursements for medical services may discourage doctors from putting in face time with patients—leaving physician assistants to pick up the slack.
This growing reliance on physician assistants has made the job more appealing and competitive. Training usually requires a bachelor’s degree, some health care experience, completion of a two-year master’s degree program as well as the passing of an exam. Applications to physician assistant programs increased more than 10% to almost 18,000 in 2011.
Duke University, which runs the oldest and highest-ranked physician assistant program in the country, according to U.S. News & World Report, had more than 1,200 applicants for the 84-seat class that entered the program last month, an admissions rate of less than 7%. That’s almost as competitive as many medical schools.
But for college graduates wary of taking on the years of debt necessary to earn a medical degree, a career as a physician assistant may seem more appealing. Assistants earn an average salary of $90,000, compared with $166,000 for doctors. Physician assistant training might even pay off more than medical school for women, according to one study.
Follow @wingrassnews
No comments:
Post a Comment