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Stones & Bones / health care / volume 10 number 6, June 2008 DOSE OF REALITY Some weeks ago, I was having trouble walking, so I called my family practice doctor’s clinic for an appointment. Yes, I could get one, but in seven weeks. After some whining on my part, I was told that I could come in the next day. Being on Medicare and having heard about the reluctance of physicians to see Medicare patients, I had expected that I might have a problem even getting in to see a doctor, but there was no discussion about that at all. After painfully hobbling into the clinic I was ushered into a room where I was met shortly thereafter, not by my regular doctor, but by a physician assistant (PA). He examined my knees and concluded that x-rays were in order. After they were taken, the PA led me to the orthopedic section of the clinic where another PA took over. He examined the x-rays, gave me some steroid shots, and prescribed a series of five weekly maintenance injections, which he would administer. I never saw an MD at all, but, pain-free, I practically danced out of the clinic thinking that I had received excellent and timely care from these two physician assistants. It was obvious to me that they both knew what they were doing. This event caused me to look into the role of physician assistants and their qualifications. I learned that in Alaska and elsewhere PAs, like physicians, are licensed to practice by the state. Alaska requires that applicants graduate from an accredited PA program and then pass the Physician Assistant National Certification Exam administered by the National Commission on Certification of Physician Assistants. Licensing also requires the signature of a licensed physician in the applicant’s area of practice who will supervise the PA in his or her work. For admission, many physician assistant programs require the applicant to have two years of college and some experience in health care. People coming into the programs often have backgrounds as registered nurses, military corpsmen, medical technicians, or paramedics. Training programs include classroom instruction in biology, English, chemistry, mathematics, pathology, human anatomy, physiology, clinical pharmacology, clinical medicine, disease prevention, medical ethics, and other relevant topics. The students also are provided supervised clinical training in several areas that may include family medicine, internal medicine, surgery, prenatal care, gynecology, geriatrics, or emergency medicine. During the course of training the students may serve one or more rotations working under the supervision of a physician who is seeking to hire a PA, and that may lead to a permanent position after graduation. After completing the program, the student may receive an associate degree, a bachelor’s degree, or a master’s degree, according to the amount and nature of the classes and other studies the new PA undertook. The physician assistant’s education is not over yet, however. To maintain certification the PA must log 100 hours of continuing education every two years, and must be recertified by examination every six years. While practicing, the PA must work under the supervision of a physician who is physically present or is available for consultation by telecommunication systems or other means. Although PAs have less formal education than physicians and do not undergo internships or residencies, they do otherwise receive extensive medical training. From a patient’s perspective, this all means that the normal preventive and diagnostic care received from a PA is comparable to that received from a physician, and the patient can expect that complex issues will be referred to the physician who supervises the PA. Highly significant for older patients—those on Medicare—is the federal requirement that all PAs must accept Medicare assignment. Physicians may chose to opt out of Medicare and charge more than the Medicare allowances for services given, but PAs cannot. Thus the patient knows that any Medicare-covered treatment received from a PA will be paid for under the usual Medicare rules. This is true even if the supervising physician does not accept Medicare assignment. All of the major clinics in the Fairbanks area participate in Medicare, and that means that any care given to Medicare patients here is covered by Medicare. However, the kicker is that the clinics, for the most part, are not accepting new Medicare patients. If a new patient is accepted, that patient probably will have to agree to accept treatment from a PA rather than a physician. Going by what I experienced and learned, a patient should agree to this restriction because he or she is more likely to get timely medical care, and can expect that the care will be high quality. As time goes by we can probably expect to see physician assistants take on an increased role in providing Alaskans with medical care, particularly in the state’s rural areas. In 2007, 389 PAs were licensed to practice inAlaska, and we have about 1,400 licensed physicians. Neil Davis is a retired geophysicist and author of several fiction and nonfiction books. His most recent book is Mired in the Health Care Morass. More on health care issues can be found at his blog, http://healthcaremorass.blogspot.com. Neil can be contacted at neildavs@mosquitonet.com. | ||
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