PA Prescribing Authority Vital to Care Delivery

A recent letter published on ACEPnow.com expressed frustration with the scope of practice of PAs and NPs. Letters like this one disregard the extent that PAs and other providers are not only integrated into the healthcare systems of the United States, but are vital to it.

First and foremost, PAs practice medicine in every medical and surgical specialty and setting. Collaborating with physicians, PAs are educated to seamlessly work in a team-based practice as versatile healthcare providers in all aspects of care delivery.

Historically, PAs are leaders in team-based medicine, a model shown to have real benefits to patient care and outcomes. PAs have a proven track record as clinical providers who add value to the delivery of healthcare. Studies have shown that PAs safely and effectively deliver care to patients, increasing patient engagement, patient access, and improving quality and continuity of care in hospitals and practices throughout the United States.

The only constant in medicine is change, and there are many procedures that were once thought to be "physician only." I served as a paramedic in the 1970s, a time when the concept was considered controversial. I remember well the outcry of medical societies in many communities, aghast at the thought that paramedics would be allowed to intubate, give emergency medications, and manage advanced life support with the remote support of physicians. Since the first paramedic program in Seattle in 1969, mobile intensive-care systems have not only become commonplace, but result in access to quick, life-saving care from the care teams who staff these units.

Like that of any medical provider, PAs' scope of practice is largely determined by education and experience. It is common for PAs to serve as the sole healthcare provider in many rural and underserved areas, providing services to patients who need care quickly. In fact, a study published in the journal Health Affairs found about half of respondents preferred to see a PA instead of waiting longer for care. These findings show that, like the early days of paramedics, when care is provided throughout the full spectrum of the health system, both patients and providers benefit.

Currently, all 50 states and the District of Columbia authorize PAs to prescribe medication. In fact, 39 states and DC authorize PAs to prescribe up to and including Schedule II drugs, working with our physicians to determine the specifics of prescribing.

There is no evidence of safety issues when comparing PA prescribing to our physician partners, largely due to the extensive training PAs receive. PAs are educated in a model similar to our physician counterparts, with many years' experience in practice prescribing in partnership with physicians.

The average PA enters an education program with a bachelor's degree and four years of health care experience. The average PA program in the United States takes 27 months to complete. PA students take more than 400 hours in basic sciences (with more than 75 hours in pharmacology) plus approximately 175 hours in behavioral sciences and nearly 580 hours of clinical medicine. Training is completed with more than 2,000 hours of clinical rotations.

As healthcare delivery increasingly moves to value- and team-based care delivery models, lawmakers have recognized the skills and qualifications of PAs, with 49 states and the District of Columbia making 184 improvements to laws and regulations enhancing how PAs practice medicine to benefit patients - more than any other year since the profession was born nearly 50 years ago.

Those of us, from physicians, to PAs, to patients in need of quality and accessible care, who have experienced the power of the team in the delivery of healthcare in the United States, can attest that the whole is greater than the sum of the parts.

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