Physician assistants: The future of medicine?
Originally published in Fauquier Times
If you haven’t already encountered the moment of truth, you will. You call your doctor – primary or specialist – and ask for an appointment for that nagging lower back pain: “We can’t get you in for two weeks. Would you like to see a physician assistant? "
What? Of course not, I want to see a doctor, my doctor.
But then again, two weeks?
So, you book an appointment with a PA but are left feeling disappointed a Doctor of Medicine will not be evaluating your painful lumbar discs.
But not so fast. The pending appointment could well be one of the more rewarding medical visits you’ve encountered. Physician assistants are gaining both in numbers and popularity for many well-earned reasons.
Dr. Eugene A. Stead with Duke University launched the first formal educational program for physician assistants in 1965. He saw a growing need for help with his office practice and was impressed with the level of skill and intelligence nurses returning from Vietnam exhibited. Here were veterans ready to serve in the private sector.
From a mere handful of practitioners in 1967, when the program was formally established, today more than 123,000 physician assistants are meeting the medical needs of tens of thousands of patients in the United States. There are 3,200 PAs in Virginia and an estimated 40 serving the Fauquier County area.
By comparison, in 2013, there were more than 1 million doctors in the U.S. But last year the number dropped to around 953,000; a figure that may be headed even further south.
Declining M.D. prestige?
Scores of doctors today are being forced to adapt to transformational changes, changes that often eviscerate the pride and satisfaction of a career in healing. Expansion of health insurance coverage through the Affordable Care Act to include 20 million people coupled with changes in Medicare are revamping how physicians are paid.
Added to the compensation issue is a pronounced increase in hours spent in administering patient computer files and insurance company claims. As an example, the implementation of a system called ICD-10 raised the number of disease classification codes physicians use from 14,000 to 68,000. Ponder the impact on record-keeping with just that change.
The overall effect has been to send a chill throughout the medical industry centered on physician burnout. It’s simply not as gratifying to make people well as it used to be.
Further, the “corporatization” of health care, including ongoing mergers of hospitals, can place more focus on the bottom line, which can be a detriment to patient welfare.
Under this broad scenario, it’s projected by 2025 there will be a nationwide deficit of 90,400 doctors. Underscoring the bleak picture is the alarming trend of doctor suicide. One doctor commits suicide in the U.S. every day, the highest rate of any profession and twice the suicide rate of the general population.
Stress and depression are the leading causes and physicians need relief on multiple fronts. PAs seek to ease the workload for many of these overburdened doctors while delivering quality care.
Physician assistant ascendency
To underscore the expansion of this unique specialty, the profession has grown more than 54 percent in just the last eight years. Annually more than 400 million patient interactions unfold under the experienced care of PAs.
And lest you think the educational requirements to practice as a PA are relatively undemanding, consider the cohort must earn a four-year college degree followed by a three-year master’s degree in physician assistant medicine. Moreover, many doctors seek PAs who have additional experience as an EMT, paramedic or nurse.
Suffice it to say, you’re in good hands with a rigorously trained PA.
Once ensconced in a white coat environment, PAs can perform most of the functions of a regular doctor, including conducting physical exams, diagnosing and treating illnesses, ordering and interpreting tests such as X-rays, MRIs, blood work and prescribing medications.
“I feel PAs are an integral part of a health care team. With the population aging and expansion of Medicaid, there is a growing need for health care. The PA profession is rising to meet that need,” said Rose Rutherford, president of the Virginia Academy of Physician Assistants adding, “People who enjoy people gravitate toward the medical practice. They are happy with their careers.”
And it shows in how they interact with patients. It’s not unusual for someone seen by a PA to have a positive reaction with the encounter.
In 1980, 36 percent of PAs were female. Today that number is 68 percent, underscoring the advancement of women in the workforce and the nature of caregiving by women. PAs typically spend more time with a patient, listening and providing care and health advice than a physician can and does.
But whether a PA is male or female, the perception of many patients is that a more positive medical interface can be achieved when being seen by a PA.
Longtime Fauquier PA
One of the most experienced PAs in Virginia works in Warrenton. Michele Glowicki is the senior PA at Blue Ridge Orthopaedic & Spine Center and supervises the work of four other PAs.
Raised in Alexandria, she obtained her degree to practice in 1984 and has spent 34 years treating patients.
“There are generally two reactions when patients encounter PAs,” said Glowicki. “The first group doesn’t want to see one. They want to see a doctor. But other patients like to see us versus a physician because we do spend, on average, more time with them than a doctor does.”
However, she underscores a theme heard whenever the subject of PAs arises in a clinical setting.
“The second group realizes we are a team and do have the resources of a physician available. They feel comfortable with us treating them.”
The team concept of medical practice is embedded in today’s medical world. For previously mentioned reasons physicians are increasingly relying on PAs to help provide comprehensive care for their patient panel.
“In my years of experience, I do have patients that I follow but when I feel the need for them to see a surgeon we go back and forth as needed acting as a team to treat each individual,” Glowicki said.
Echoing the pressures placed on doctors today, Glowicki adds, “I think that’s the way medicine is working today. Physicians are under pressure, not being fairly reimbursed, and if a doctor can use a PA I think the patients are better served.”
On the subject of compensation, it might appear doctors are, in fact, well compensated for their skills. On average, physician incomes range from $200,000 to more than $300,000 annually based on the type of medicine they practice. Surgeons fall into the higher income ranges.
But stagnating compensation appears to be a real problem with many physicians seeing their incomes fail to keep place with the cost of living. Many have worked decades and invested heavily to achieve their high earning years only to see their compensation flatline.
PAs salaries reflect the importance of their growing contribution to medicine and range from $100,000 to $120,000, again, depending on the discipline they’ve chosen to pursue. Working alongside surgeons reaps higher rewards.
With industry estimates of up to a 43 percent of doctors considering cutting back, retiring or switching to non-clinical work, the future of physician assistants appears bright. So, if faced with a decision to see a doctor or PA in the future, consider embracing the future of medicine and give a PA an opportunity to heal.
