Physician assistants can help ease the challenges in your practice

By Karrie Lynn Crosby, MPAS, PA-C

The shortage of primary care physicians in Texas and the increasing demands of a growing-insured population have converged to create a heavy burden for physicians, especially those in family medicine. Other issues abound: physicians are being challenged by significant changes in the profession; they are concerned about health care reform and how it will affect the way they practice and care for their patients; new processes make it hard to stay on schedule; work days are getting longer; and the reimbursement structure is changing. Rightfully so, family physicians are concerned for their quality of life and the future of their practice.

Physician assistants are keenly aware of the stresses on the physicians they work with and are well equipped to be a part of the solution. Certified PAs are educated in the medical model to work alongside their physician partners.

We do not seek independent practice; rather we are allies to our supervising physicians, supporting the team-based practice model that involves all providers being utilized to the full extent of their education and licensure. We want to help practices continue to deliver quality care and alleviate some of the physicians’ challenges, which ultimately benefits the patients.

The PA mindset

A PA’s job is to help make the team successful. We work closely with our physicians to improve the lives of our patients. It is a phenomenal partnership that my physician partners would not want to give up. They see us as a team, and they know we share their goals.

I enjoy working in family medicine, probably for the same reasons you do. It affords the opportunity to develop important relationships with patients and their families. My personal philosophy is to meet our patients at their level of concern and understanding. It is important to listen and really hear what they have to say. They come in with an agenda and don’t always spell it out; we have to investigate and get to the root of the real problem. As family medicine providers, we seek to understand the whole patient, their life stressors and their family environment. Rapport develops over time, and they become comfortable sharing the whole picture. This unique opportunity allows us to have a relationship that, in the long run, enhances their care.

Patients are consumers; they have a choice of whom they want to see, and quality measures will define the care we give in new ways. Patients need to trust us and understand how we arrive at decisions, or they won’t follow our advice. PAs are trained to discuss preventive medicine, and we try to explain to patients their role in managing their own health.

PAs at Scott & White provide many benefits

Michael Reis, M.D., who chairs the Department of Family Medicine at Scott & White Healthcare, points out that physicians have to be willing to share responsibility with PAs. “In the past, physicians were trained to do everything, and delegation was discouraged. But the world has changed, and team-based care is the norm.

“PAs are a second set of eyes and ears to manage patients,” Reis says. “By being engaged in the health care team, they are valued partners who help us contribute to quality outcomes. They also allow us to expand our panel of patients, extending the physician’s reach to a growing patient population.”

At Scott & White family medicine clinics, PAs see a larger load of acute care patients, but we also have pre-scheduled patient appointments and manage chronic conditions. PAs can be very helpful in the area of population management.

When I came to Scott & White, there were less than 100 advanced practice professionals (including PAs, nurse anesthetists, and nurse practitioners), and that number has more than tripled in the last three years. Our physician partners have appreciated the ways we enhance their practice. In private family practices across Texas, PAs are growing in numbers as well.

According to the National Commission on Certification of Physician Assistants, there are currently more than 95,000 certified PAs in the United States. NCCPA estimates:

• More than 20,000 of those work in family medicine,
• There are more than 7,600 certified PAs in Texas, and
• More than 2,000 of the PAs in Texas work in family medicine.

At Scott & White, certified physician assistants are used in most clinical specialties. We have documented that utilizing certified PAs can help improve access, maximize same-day appointments, enhance preventative care, decrease length of hospital stay and are cost-effective, contributing positively to the bottom line.

Scott & White has always had a quality-centered approach to health care, following evidence-based medicine, so what is required to support the patient-centered medical home model and an accountable care organization is not new to us. Part of our success in these areas is the team-based model which fully utilizes PAs and other advanced practice professionals.

What has changed in this age of health care reform is that we now document that care using a standardized approach through electronic health records. This will allow us to demonstrate outcomes and prove our quality assurance measures.

Considerations when hiring a PA

Physicians often ask how they can utilize PAs to provide access to more patients. Obviously different practice models will utilize PAs in different ways, depending on the patient population, setting and specialty. Seven things to consider are:

Review state guidelines and regulatory standards. In Texas, PAs are allowed to prescribe dangerous drugs and CIII-V medications in the clinic settings, with added CII delegated prescribing in facility based practice settings and hospice; one physician can supervise up to seven PAs; and there is no distance limitation for physician supervision, making it easier to provide care in rural and underserved areas.

Talk to your physician colleagues. Ask them how they integrate PAs into their practice and how they effectively utilize PAs to increase patient access and decrease physician overload. Each practice setting will utilize PAs in a different way based on the needs of the practice.

Determine how you want to utilize a PA. Will the PAs see walk-in patients or those with scheduled appointments? Will they concentrate on chronic disease management or wellness exams? Will your model be dual care, where a PA sees the patient and the physician joins in at the end to answer questions? Or will PAs have their own patient panel and bring you in only for consults as needed?

Decide whether to hire experience or a new grad. This depends on the physician’s or employer’s vision for the practice. Do you want a PA who can hit the ground at full speed, or would you rather hire a new graduate that you can mold in your methodology? Cost may weigh into this decision as well.

Volunteer to be a preceptor. This has worked well at Scott & White. Yes, it takes time, but you get to train them in the way you practice. It is a way to try out a PA for a designated period of time. If the collaboration works well, you can hire them before others have a chance. Nationally, 30 percent of PA graduates find their first job with a preceptor.

Allow your PA to practice to the full extent of their license. PAs want to contribute to the practice as much as possible. Many PAs say they could do more when given the opportunity, and would appreciate being able to continue to learn from their physician partners. We want to earn their respect and trust.

Explain team-based care to your patients. Have a plan in place to introduce the PA and explain what they will do and how you will work together. Studies show that patients often choose to see a PA if they can be seen sooner.

Why you can count on PAs

Certified PAs are highly educated medical providers who graduate from accredited, masters-degree level PA programs, pass a rigorous national certification exam, and maintain certification through ongoing education and recertification exams. They are also licensed by state medical boards.

PAs routinely obtain medical histories; examine, diagnose, and treat patients; order and interpret diagnostic tests; and develop and implement treatment plans. They can perform minor surgery and assist in major surgery; instruct and counsel patients; order or carry out therapy; and prescribe medications.

According to NCCPA, every week certified PAs work 3.8 million hours enabling them to increase health care access by seeing 7 million patients in every clinical setting across the U.S.

A recent NCCPA survey shows that access to good, affordable health care now trumps virtually every other societal concern and indicates that more consumers are ready for PAs to play a greater role in their care. For physicians in family practice who are being squeezed between patient demands and hours in the day, certified physician assistants might help transform your practice into one that you envision for your future.

Karrie Lynn Crosby, MPAS, PA-C, is President of the Texas Academy of Physician Assistants. A PA at Scott & White for 16 years, Karrie is a member of its Advanced Practice Professional Council, made up of PAs, nurse practitioners and clinical nurse anesthetists. She is also the first non-physician provider to have a voting seat on the Clinic Staff Organization, which represents physicians. In her 20 year career, 18 of those years have been in family medicine.