Physician assistants could expand access to health care

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Capital News Service
LANSING — Patients would gain greater access to health care if lawmakers approve a bill that would let physician assistants practice with less supervision and make it easier for some of them to prescribe drugs.
The measure would make Michigan the first state to offer that level of autonomy.
The idea is to help physician assistants better reach and serve patients, said Michael DeGrow, executive director for the Michigan Academy of Physician Assistants. The legislation will make it easier for them to practice in many different counties.
For example, if you’re homebound with a chronic condition in rural Northern Michigan, multiple visits to outpatient health care may not be possible. Physician assistants can help better serve these patients, DeGrow said.
Current law creates a burdensome reliance on physicians when prescribing medicine, he said. This bill would relieve that bottleneck, while allowing individual physicians to decide the terms of oversight that best fits their practice.
Physician assistant education follows a broad healthcare curriculum. It’s similar to physician education, but does not substitute for it, DeGrow said. That is why physician assistants value the ability to stay connected to physicians for questions, whether that means practicing in the same office or making a phone call to their physician in an office elsewhere. But giving physician assistants the opportunity to be licensed prescribers- within the terms outlined by the physician they partner with- would make it easier for patients to get quick, effective, quality care, he said.
Studies reveal that patients are equally satisfied with medical care offered by both physician assistants and doctors, according to the American Academy of Physician Assistants. This legislation lets physicians delegate services to physician assistants already competent in those areas.
The bill, prompted by the shortage of physicians in Michigan and nationwide, is sponsored by three physicians–Reps. Ned Canfield, R-Sebewaing; John Bizon, R-Battle Creek; and Hank Vaupel, R-Fowlerville. The House approved it with little opposition. The Senate Committee on Health Policy also approved it. Supporters are hopeful to get full Senate approval and then signed by the governor before the end of the year.  
“It modernizes the language of the public health code to better mirror how physician assistants and physicians work together,” Canfield said. “This will help streamline the process and oversight role for the health care providers.”
The bill would mean that physicians would not have to supervise their physician assistants as much. Michigan had 3,845 physician assistants licensed in 2016.
It would also give physician assistants permission to prescribe drugs without a physician’s endorsement. Michigan would be the first state to give this level of autonomy to physician assistants.
Low-income and rural communities that struggle to attract health care providers would especially benefit. The ratio of population to primary care physicians varies dramatically throughout Michigan, according to the University of Wisconsin Population Health Institute. And access to primary care physicians is an important factor determining the health of a community.
Counties in the 90th percentile for national performance in health care have a population-to-physician ratio of 1,040 people to 1 doctor, according to the American Medical Association.
But 69 of Michigan’s 83 counties have ratios below that. Among Michigan’s worst: Missaukee (3763 to 1), Allegan (4,168 to 1), Cass (5,191 to 1), Lake (5,693 to1) and Presque Isle (6,531 to 1). Among the state’s best: Washtenaw (579 to 1), Oakland (662 to1), Grand Traverse (687 to 1), Luce (813 to1) and Emmet (850 to 1). In Presque Isle County has nearly six times the recommended population per one physician.
The changes would be outlined in a contract for the physician to determine how much supervision is needed. The Michigan Board of Medicine could also impose restraints on physician assistants.
“We are removing the concept of supervision and delegation and replacing it with a contractual arrangement between a physician and physician assistant,” DeGrow said. “The practice agreement really empowers both parties to work together to address their individual needs.”
Giving physician assistants greater autonomy does not make them independent of physician oversight, DeGrow said.
“Physician assistants will always have a subset of the skills physicians have – they have excellent training, but that can’t replace the knowledge of a doctor,” he said.
Physician assistants must attend an accredited three-year physician assistant program beyond a four-year undergraduate degree, become certified and maintain a state license. They do not attend four years of medical school or complete a residency like medical doctors and doctors of osteopathic medicine.
A recent law allows physician assistants to hold majority ownership in a practice, enabling more of them to operate satellite clinics with access to a physician by phone.
The new legislation would grant them even greater autonomy, particularly in rural areas where many are already practicing without a physician on site.
This opens the door to greater access for underserved communities across the state, supporter say.
“Michigan faces a major primary care shortage,” said Todd Ross, manager of communications for the Michigan Osteopathic Association. “The trend is that more physicians are choosing to specialize and practice in urban areas.”
Satellite clinics and home care are two other areas where the need for health care is growing and less micromanagement could improve efficiency for the physician and access for the patients, DeGrow said.
“As the baby boomer generation ages, there are going to be a lot more homebound patients,” DeGrow said. With physicians retiring as well, this is going to create an even greater shortage in health care providers, he said.

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