| It is becoming increasingly common for patients to see physician assistants, often referred to as mid-level professionals or advanced care practitioners, when they visit a doctor’s office or medical clinic. And, not surprisingly, it’s a growing field. There are nearly 59,000 physician’s assistants in practice in the United States today, with another 10,000 students currently enrolled in PA programs, according to estimates by the American Academy of Physicians Assistants.
There are several reasons for the increasing prevalence of these advanced care practitioners. Busy medical practices often rely on these providers to help meet increasing patient demands. It is less expensive to hire a physician assistant than to hire an MD. And, in some cases, these advanced care practitioners are often the only option for medical treatment, particularly in rural areas where doctors are in short supply.
With advanced care practitioners helping to change the medical landscape, what does that mean for the quality of care that patients receive?
“The quality of care should be the same,” said Monica Morrison, president of the Washington State Academy of Physician Assistants, and currently an instructor with MEDEX Northwest, the University of Washington School of Medicine’s Physician Assistant program. “I don’t think [PAs] are an increased risk for liability. Like any provider, it depends on the provider.”
Statistics back that up. According to the National Practitioner Data Bank’s 2003 Annual Report, 882 (or .4 percent) physician assistants had a malpractice report made against them in the United States between 1990 and 2003, compared to 141,971 (69 percent) of physicians in the same time period.
Physician assistants are not simply glorified medical office staff. They require rigorous training and certification before being eligible to practice. Physician assistants are trained in the same model that was used to move students quickly through medical school during World War II, Morrison said, and they are eligible to be certified as a PA only after completing a standardized course of study through an accredited PA program.
“These are highly trained individuals,” said Dr Michael Soman, executive medical director, Puget Sound region, for Group Health Cooperative, which uses mid-level professionals extensively at its clinics.
You’ll find advanced care practitioners in both primary care and specialty environments, and they see patients for a wide range of ailments and routine medical care, from colds to annual exams to follow-ups for surgery and urgent care treatment. Most states, including Washington, also allow physician assistants to write prescriptions.
“Physician assistants can provide about 80 percent of the care a physician can, said Morrison.
Physician assistants work in partnership with medical doctors, and must work in some kind of supervisory relationship. Even physician assistants that work “out on their own” in rural settings work in partnership with a physician in the general vicinity.
“PAs are part of the team,” said Morrison. This team approach to medical care is a growing trend in health care, she continued, with doctors, physician assistants, nurses, nurse practitioners and even pharmacists working closely together as medicine grows ever more complex and specialized.
When Morrison was in practice, she shared a similar case load as the physician, seeing roughly 20 patients a day. While most of the time she could treat the patient on her own, “If I saw a complex issue I would ask the doctor to take a look.”
This team approach also means that in an instance of a malpractice lawsuit against a physician assistant, the supervisory physician would also be named. Because of this, it is definitely in the best interest of the physician to ensure that they are hiring the most qualified advanced care practitioners.
While Morrison does anticipate that physician assistants will be at higher risk for liability in the future, due simply to increasing numbers of practitioners in the field, she believes that one reason that physician assistants have so far enjoyed such glowing lawsuit statistics is because of communication, said Morrison.
“Suing has to do with relating to patients,” she said. Patients sue when they feel that there hasn’t been a good outcome, she continued. Establishing a good relationship with a patient and communicating with them clearly helps ensure patients receive the treatment they expect. While its not necessarily true that physician assistants spend more time with patients than doctors — most physician assistants have just as heavy a patient load as doctors — physician assistant training programs stress good communication, and physician assistants are often more accessible than doctors, giving patients the impression that physician assistants pay more attention to them.
Morrison admits that despite the increasing prevalence of advanced care practitioners in the medical fields, there are still a few hurdles that physician assistants need to surmount. Because patients don’t know as much about them as doctors, physician assistants don’t have the luxury of getting the automatic respect that many patients confer to MDs.
“It’s important to be really competent,” she said. “I tell my students that each physician assistant represents the whole profession. You can’t just be good enough; you have to be better.”
Ultimately, Morrison said, it’s a matter of educating the public about the profession and making sure that patients are comfortable.
“Once you’ve demonstrated to them you can help them, you’ve done your job,” she said. | 
