News & Analysis

Physician Assistants: the Future of Team-Based Care?

Portrait of Dawn Carter

Dawn Carter

A physician assistant takes the blood pressure of a patient

What’s in a name? There’s a battle brewing over the familiar P.A. designation found in many primary care teams, and it’s just one more sign of the status quo resisting true healthcare transformation.

As reported recently by Kaiser Health News, physician assistants would like to re-brand as “physician associates,” but doctors are fighting back, arguing that the move will confuse patients and degrade care.

This battle over nomenclature may be somewhat arcane, but it’s highly relevant to hospitals and health systems trying to deliver the best care at the lowest cost.

Physician Assistants and Healthcare Transformation

We’ve been saying for years that better primary care is perhaps the single most effective way to get a handle on spiraling healthcare costs. The best hospitals and health systems are bringing physicians onto the payroll, allowing them to practice in pods, and supporting them with advanced practice providers such as physician assistants and nurse practitioners.

This kind of team-based approach is key to delivering on the promise of Primary Care Done Right, which helps to reduce reliance on high-cost specialists, ER visits, and hospital admissions. As we explained recently in a detailed whitepaper, team-based care using advanced practice providers can double a doctor’s panel size while still allowing 75% of patients to get same-day or next-day appointments.

To work most efficiently, primary care teams must allow non-physician members to practice at the top of their license, but patchwork regulations across all 50 states effectively prevent P.A.s from making their maximum contribution. In some states, for instance, P.A.s are required to have formal supervision by a physician, including regular meetings and chart reviews. Some laws also require P.A.s to have written agreements with a physician that spell out the limits of their role.

Elevating Professions, Expanding the Team

Change is coming, but it’s slower than we’d like to see. According to the National Conference of State Legislatures, last year saw the introduction of more than 70 separate bills to modify scope-of-practice laws that limit the services offered by physician assistants. Most of those bills went nowhere, thanks largely to opposition by professional groups like the American Medical Association.

At a time when many observers are still warning of a coming physician shortage, it might seem short-sighted for groups like the AMA to fight for laws that put the brakes on expanded care, especially given the unprecedented professional burnout as a result of the Covid-19 pandemic.

Our proprietary modeling shows that the predicted physician shortage would disappear if physician assistants, nurse practitioners, and other advanced professionals were allowed to practice at the top of their license. Besides relieving the upward pressure on physician salaries, that single policy change would also improve health outcomes by encouraging more preventive care visits, routine checkups, and the like.

Whether we call them physician assistants or physician associates, P.A.s will play a vital role in controlling healthcare costs and improving access for patients – but only when we take off the shackles and make them an integral part of the primary care team.