This issue brief describes the role of PAs in the U.S. health care system and barriers that may prevent PAs from being used to maximum effect. The brief concludes with specific policy considerations for state leaders who are interested in getting the greatest value from their PA workforce.
Physician assistants (PAs) make up a small but rapidly expanding part of the health care workforce. Their training and education produce a sophisticated and flexible medical professional who can function in many specialty areas and within many practice structures. Because of their adaptability and lower cost, PAs can play an important role in the health care delivery system.
PAs deliver medical and surgical care in teams with physicians, who provide medical supervision and delegate tasks to the PAs. The scope of practice for PAs is set by state laws and regulations, which determine the types of services they can provide and the circumstances in which they are allowed to provide them. Most states grant physicians the flexibility to determine the range of medical tasks they can delegate to PAs and the method of supervision. Some states are more explicit regarding supervisory or practice requirements and may mandate that physicians review a certain percentage of charts or be onsite with the PA for a specific percentage of time, although no state requires PAs and physicians to practice continuously at the same site.
Many experts see PAs as important contributors to emerging strategies to deliver health care more efficiently and effectively, but important barriers exist that could slow the growth of the profession. For example, state laws and regulations may not be broad enough to encompass the professional competencies of PAs. In addition, state statutes and regulations impose widely diverse restrictions on physicians’ ability to delegate authority to PAs, which, in some instances, are overly strict. However, limited research exists that evaluates the quality of care that PAs provide under different supervisory and scope-of-practice arrangements to support reducing such restrictions. In addition, PA training programs face the same shortage of clinical training locations that most clinically based professional programs are experiencing. Finally, limited data indicate that PAs, like physicians, respond to economic incentives by shifting away from primary care and underserved communities in favor of higherpaying specialty care.
Governors seeking to take full advantage of the PA workforce in their states may review the laws and regulations affecting the profession and consider actions to increase the future supply of PAs. Most states grant PAs legal standing to provide care based on their skills and training. In states that do not, a first step is to expressly incorporate PAs as providers of medical services in both law and regulation. A next step is to evaluate whether the laws and regulations governing the scope of practice granted to PAs are sufficiently broad to allow PAs to work to the full scope of their professional training. State policymakers confronted with long-term shortages of primary care physicians or other specialties also may consider facilitating greater educational opportunities for PAs; for example, by coordinating clinical training programs. This approach would be effective at reducing shortages in specific specialties or areas, such as low-income or rural areas, if combined with financial incentives that encourage PAs to practice in those specialties or areas.