Free PAs, NPs from Barriers to Providing Excellent Patient Care

We are now less that one year away from the full implementation of the Affordable Care Act, more commonly known as "Obamacare." There is no shortage of prognostication among experts and pundits as to what this means.

One thing that virtually everyone agrees on is that there are not enough primary-care providers to meet present and foreseeable demand for direct-care providers such as physicians, physician assistants, and nurse practitioners.

A recent Los Angeles Times article reported that state Sen. Ed Hernandez (D-West Covina), chair of the Senate Health Committee in California, is working on a bill to look at scope of practice issues as they relate to providers other than physicians as a way to improve access to care. California has an acute shortage of healthcare providers, which will only get worse as the healthcare reform law comes online early next year. This issue is not unique to the Golden State. A simple Internet search shows that similar initiatives are being considered elsewhere as states grapple with how best to meet the needs of their residents in the face of significant shortages of physicians and other providers.

What surprises me is that possible solutions to this shortage are coming from the legislature and not from medical professionals.

I attended an annual facility medical staff meeting a couple of years ago, and we were fortunate enough to have Sacramento Bee columnist Dan Walters speak. He covered the capital political scene for decades, and talked frankly about how the sausage gets made, especially how it relates to healthcare law.

He observed that the policymakers in our state houses are by-and-large not experts in direct healthcare delivery. And yet, issues relating to healthcare delivery system and methods are most often addressed in the political realm.

As we prepare for a dramatic shift in healthcare policy and delivery, there are things that patients, providers, and lawmakers should realize.

The physician assistant and nurse practitioner education program is much shorter than their physician colleagues. We need to train as many physicians as we possibly can into the foreseeable future, but that alone will not create enough providers - and legislators and health policy analysts need to know this. The production of physicians has not markedly increased over the past couple of decades, and a significant portion of the profession is approaching retirement age. So a team approach to healthcare delivery is the only option to ensure a provider population exists to care for patients.

Team practice is the norm now, and making it easier to use other providers in physician-led teams just makes sense. In one of my previous blogs, I talked about a Heath Affairs article that challenged assumptions as to how we traditionally determined how many physicians and other providers are needed in our population. Better utilization of physicians and other providers like PAs and NPs, improving team practice, and better use of technology in the practice of medicine goes a long way in alleviating the shortage of healthcare providers.

Which brings me to my final observation, which sometimes creates some dissension between and among physicians and other providers. We have to find a way to remove barriers to efficient team practice for PAs and NPs so that all healthcare providers can practice to the fullest extent of their knowledge and education.

Legislatures are rapidly coming to the realization that the traditional methods of healthcare delivery can no longer help patients seeking access to high-quality healthcare. There is a new political impetus driving how we govern and regulate our professions, brought on by the Affordable Care Act. It is my hope that we look at barriers to effective healthcare delivery objectively and do what is right to enhance the function of teams for our patients

Together is the only way we are going to be able meet the challenges facing physicians and other providers in serving the healthcare needs of the patients who rely on us for care.

This blog was provided in partnership with the American Academy of Physician Assistants.