As physician assistants and other midlevel health
professionals fill growing gaps in primary health care, turf battles are
erupting in many states over what they can and can't do in medical practices.
One of the bitterest fights is in Kentucky, where physician
assistants are lobbying the state legislature to repeal a law that says that
for the first 18 months after certification, physician assistants are allowed
to treat patients only when a supervising physician is on site. Being in phone
contact isn't deemed sufficient.
The Kentucky Medical Association, which represents doctors
in the state, says it is still evaluating the bill. But it helped push for an
on-site requirement in 2003 and helped block two previous attempts to rescind
the 18-month rule, on the grounds that physician assistants have far less
experience than physicians and benefit from more supervision.
PAs, as they are known, are licensed to practice medicine as
part of a physician-led team. Their "scope of practice" rules vary
from state to state, but PAs can generally do whatever tasks the doctor
delegates to them within those rules, including examining patients, prescribing
medications, conducting rounds in hospitals—even closing surgical incisions—as
needed. About 80% have master's degrees, with an average of 27 months of
classroom and clinical work after college.
Demand for PAs has grown, particularly in primary care and
rural areas, as more doctors choose to specialize and work in urban settings.
That demand is expected to increase further when the federal health law next
year extends coverage to millions more Americans, likely prompting many of them
to seek care.
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