Why PAs are Being Used More in Hospitals

In my 35 years practicing medicine as a PA, I have witnessed a profound change in how PAs are utilized in the healthcare system. Our profession began at a time when a general practice physician shortage was looming and  the specialization of medicine was just beginning to boom.

PAs traditionally worked in teams with physicians, so it only made sense that they would go the way of physicians. PAs have proved their utility, safety, and efficiency over and over again in every specialty and subspecialty, and now in every setting. When I began practice in 1982, PAs working in hospitals on the west coast were a rarity. Now, the percentage of PAs who spend at least part of their time practicing in the hospital environment is significant.

More than 50 percent of the 109,000 PAs currently practicing in the U.S. healthcare system work in a hospital environment, according to a report recent released by the American Academy of PAs (AAPA).

These trends are accelerating for a number of reasons.

In November, The Baltimore Sun published an article about PA utilization on hospitalist teams at Anne Arundel Medical Center.  The reason for giving PAs more of a role and greater autonomy within that hospital was driven by a number of trends, not the least of which was the shortage of physicians, and the passage of the Affordable Care Act, which provided millions of Americans health insurance, some for the very first time in their lives.

The Chief of the Division of Internal Medicine at Anne Arundel Medical Center, Timothy M. Capstack, an internal medicine physician, says its model to be very safe and effective. They recently tested their model against a hospital unit run by mainly physicians, and found no appreciable difference in outcomes from hospital stays in the two units.

This Johns Hopkins University study that prompted the article was recently published in the Journal of Clinical Outcomes Management. Over an 18-month period, researchers found that there were no statistically significant differences between the physician-only teams and physician-PA teams for in-hospital mortality, readmissions, length of stay, or consultant use. Cost of care was less in the expanded PA group. Their conclusion was an expanded PA hospitalist staffing model at a community hospital provided similar outcomes at a lower cost of care.

This study shows one approach - where they flipped the ratio and found that the patient care and volume did not suffer while the cost overall was decreased.  From what I’ve read in the study and the article, the hospital that used the physician-PA teams had clear lines of communication and understanding.  The PAs and NPs were given a level of autonomy commensurate with their experience and competency.

When I think about my own anecdotal experience as a PA working in a hospital-based surgical practice, I can validate what the researchers found when they looked at how physician-PA teams operate in the hospital environment. I’m not a physician, nor am I fully a replacement for the surgeon/physician. However, we complement each other, and I autonomously perform many of the functions previously reserved for physicians in our medical staff environment.

I’m very fortunate to work in a medical staff environment that values PAs and other providers - like NPs and CRNAs -  to create a work environment that bases our scope of practice on our level of skills, education and experience.

Together, my surgeon and I take care of a very busy, diverse, and surgically challenging patient load, and I’m able to relieve him of much of the administrative and routine consultative and hospitalist tasks that previously made his role in our practice less than satisfying. Together, we deliver more care safely, and I believe, with better outcomes than we would perform individually and alone.

There are many PAs, NPs, and CRNAs working at our facility on hospitalist, emergency, and surgical teams. We have been embraced by the medical staff and given a work environment that allows us to contribute meaningfully to the care of the facilities patients.

Medicine remains a team sport. Anything and everything we can do to enhance the function and utility of the teams is in the best interest of the patient, and in the best interest of the U.S. healthcare system.

I’m glad that as additional research is done, and as data is reported, it validates what I as a PA working in a hospital environment have always known; PAs are an important part of the solution to delivering healthcare to an ever expanding number of patients in our communities.

This is a care delivery and utilization model worth replicating.