There's a simple solution to the doctor shortage

Our hospitals and healthcare providers need to rely more on physician assistants, but red tape stands in the way

Published May 16, 2024 5:30AM (EDT)

People sitting in a doctor office waiting room. (Getty Images/SolStock)
People sitting in a doctor office waiting room. (Getty Images/SolStock)

"Our next available appointment is in February of next year."

Sadly, this is a common refrain in doctors' offices today. How many times have you tried to schedule a follow-up or a yearly physical, only to be given an absurd timeline? Meanwhile, many patients who move to a new geographic area can't find a doctor at all.

That's because we're in the midst of a nationwide physician shortage. The average wait time for a doctor's appointment in cities is 26 days. Rural residents have it worse. Their communities make up nearly two-thirds of all areas in the country with shortages of primary care providers.

Yet getting treated doesn't need to be this difficult. We may have a limited number of doctors, but there's another source of high-quality, professional care. Our hospitals and healthcare providers need to rely more on physician assistants — who at the moment, are often barred from working at the level for which they're trained. That needs to change.

Physician assistants are licensed medical professionals who handle some routine duties that would otherwise require doctors' time. Their ranks are increasing: in the past decade, the number of board-certified physician assistants grew by more than 75%.

Our hospitals and healthcare providers need to rely more on physician assistants — who at the moment, are often barred from working at the level for which they're trained.

As an emergency room doctor for more than 20 years, I witnessed their rising presence. I experienced, firsthand, how incredibly useful and even crucial physician assistants can be; they handled duties like suturing and treating minor injuries, freeing me up to focus on more complex cases.

In primary care practices, physician assistants order and interpret lab tests, prescribe medicine, and diagnose illnesses. In specialized settings, depending on their training and level of experience, they carry out countless responsibilities, from closing incision sites following surgery to performing biopsies and providing palliative care to the terminally ill.

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This essential work takes some responsibility off doctors' plates and allows more patients to be treated sooner. But in many states, physician assistants aren't allowed to practice to the full extent of their training — at the "top of their license" in industry speak. That means that even a physician assistant who had performed a procedure thousands of times would be prohibited from doing so.

Unfortunately, these limits exist in large part because doctors insist on them. Groups representing physicians are fighting legal changes that would expand the duties physician assistants may perform — known as their "scope of practice."

This could result in tragedy in medically underserved areas of the country like Mississippi, where bills to expand scope of practice were defeated last year. The Magnolia state has one of the worst physician-to-patient ratios in the country, with fewer than 200 doctors per 100,000 people. The number of certified physician assistants in the state increased by nearly half between 2018 and 2022.

Some states with similarly drastic physician shortages have taken steps to lighten the load for physicians and increase the number of patients treated. Last year, Arkansas passed legislation that enrolls physician assistants in Medicaid as "rendering providers," allowing primary care practices that serve Medicaid patients to hire physician assistants more easily.

Doctors who oppose expanding the scope of practice for other healthcare professionals say they're worried about patient safety. But physician assistants have completed two- or three-year master's degrees that include medical coursework and clinical rotations. They may have thousands of hours of experience. Moreover, a sick patient who can't see a doctor for weeks or months would surely be safer if they could see a nurse practitioner or physician assistant right away.

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The real reason some doctors oppose scope expansions seems to be financially motivated. Because of insurance company rules, practices typically see less reimbursement for work done by physician assistants. Medicare compensates work performed by nurse practitioners and physician assistants at only 85% of the amount a doctor receives. Yet doctors worried about diminishing financial returns are perceiving a scarcity that doesn't exist: there's no shortage of patients.

Neither observation nor research supports the notion that expanding scope of practice for physician assistants will hurt patients. I witnessed the transition to allowing nurse practitioners to work at the top of their license. It was a boon for patients, healthcare facilities, and overworked doctors alike. And a study performed by Health Services Research found that primary care patients who see nurse practitioners have similar health outcomes compared to patients who see physicians.

For sure, it's tough to see a doctor. But physician assistants are helping patients every day. Let’s ensure they are able to continue doing so.

By Nicole Wadsworth

Nicole Wadsworth, D.O., FACOEP, FACEP, is dean of New York Institute of Technology’s College of Osteopathic Medicine.

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Commentary Doctor Shortage Doctors Health Physician Assistants Rural Health