Allied Health Professional Roles Debated

The demand for physician assistants (PAs) and nurse practitioners (NPs) is growing, especially in rural areas and in primary care as physicians gravitate more to urban locations and to specialization. These demands will grow even faster if, as expected, the Affordable Care Act (ACA) brings an additional 30 million consumers into the healthcare system. In the midst of these trends,  many state medical associations, which represent doctors, are engaged in a lively policy debate over defining the scope of allied health professional roles.

While the PAs and NPs are licensed to practice medicine as part of a physician-led team, rules governing the practice vary from state to state. PAs can generally do any task a doctor delegates to them, including examining patients, prescribing medications, conducting rounds in hospitals, and surgical suturing. All 50 states allow PAs to write prescriptions.

Many states are debating the rules of practice for a range allied health professionals. NPs, nurse anesthetists, nurse midwives, audiologists, psychologists, and podiatrists are all using healthcare reform as an opportunity to seek broadened roles and responsibilities. In the past two years, more than 1,795 scope-of-practice bills were proposed, with only 349 enacted. These efforts to expand the scope of practice are often met with opposition from physician groups.

The Association of American Medical Colleges (AAMC) has warned that the supply of new doctors will not keep up with growing patient visits as Boomers age and the ACA brings in more patients. Due to limits on federal funding for medical residency programs, AAMC has estimated that the country will face a shortage of more than 90,000 physicians by 2020, especially in primary care and in rural areas.

Some states are expanding what PAs can do. Ohio, for example, now permits PAs to insert and remove chest tubes, and to prescribe physical therapy for patients. The American Medical Association says it supports using PAs, nurse practitioners, and other allied professionals in healthcare teams as long as they are directed by physicians and do not exceed their training. Defining the direction required from physicians is where the conflicts arise.

In Kentucky, 55 of the state’s 120 counties are already designated as medically underserved, and officials estimate that 484,000 more state residents will seek medical care next year under the ACA. Against this background of underserved patients, Kentucky has a particularly intense debate ongoing over the scope of practice for PAs.

Click here to read more in the Wall Street Journal.

Nurse Practitioner image by Eddie Harrison / Wikimedia