How Physician Assistants Improve Healthcare in Rural America
SpreeHealth
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The physician shortage in America is real, and it’s especially pronounced in rural areas. Only 11 percent of physicians work in America’s rural areas, even though almost 20 percent of the population resides there. Add to that the fact that physicians in rural areas often serve large areas that necessitate long travel times. Reaching a critical access hospital can take a long time, and this is causing concern as the rural population in America ages to include more elderly and near-elderly people.
The demand for primary care provider services in rural America is great. The importance of preventive healthcare is especially pronounced for people in rural areas of the country, and in an increasing number of cases, primary care is being provided by physician assistants.
The rural population is increasingly elderly, which means increased need for healthcare services.
As of 2012, over 40 percent of rural Medicare recipients saw either a physician assistant or nurse practitioner for all or some of their primary care, and this number is expected to increase. In response, many states are introducing legislation to expand the scope of practice for PAs, so they can help address the physician shortage in rural and other underserved areas. 
Why More Rural Areas Are Turning to Physician Assistants
In the coming decade, thousands of primary care providers will be needed to meet demand among rural Americans. Maintaining and improving health, and learning about and practicing preventive health measures is especially important in this population. People who participate in regular primary care tend to comply better with treatment plans, and have lower rates of hospitalization and premature death.
Another reason so many rural areas are turning to physician assistants to meet primary care needs is that they can provide care while helping keep costs under control. Licensure standards must be strong enough to ensure that PAs can keep up with research and advances in technology and treatment plans, to keep the positive momentum going. Preliminary findings concerning care by physician assistants in rural areas is encouraging.
- More people seek primary care when it’s delivered by advanced-practice providers like PAs, and this reduces hospitalizations.
- Quality of care provided by advanced-practice providers is comparable to that provided by physicians, and patients are generally pleased with the higher level of engagement they experience with them, compared to physicians.
- In Massachusetts, costs of care provided by nurse practitioners and physician assistants is 20 percent to 35 percent lower than costs for care provided by physicians.
Physician Assistants and Patient Satisfaction Metrics
The concept of “patient satisfaction” is being quantified to an extent never before seen, partly due to increased emphasis on patient satisfaction by policies of the Centers for Medicare and Medicaid Services (CMS). These policies tie healthcare provider reimbursement in part to patient perceptions. Increasingly, PAs are members of the care teams that serve patients on Medicare and Medicaid, and a Kaiser Commission on Medicaid study says that not only do physician assistants perform as well as physicians on outcome measures, but patients report high levels of satisfaction.
High levels of patient satisfaction with physician assistants is encouraging since patient satisfaction metrics are increasingly important for Medicare reimbursement.
A 2014 study by the National Commission on Certification of Physician Assistants (NCCPA) found that Americans’ top healthcare concern is access to high-quality, affordable care. Other top concerns include:
- Being able to schedule appointments in a timely manner.
- Avoiding long wait times once in the doctor’s office.
- Learning about health conditions as well as being treated for them.
Physician assistants are accepted by the vast majority of patients, particularly when they address these top healthcare concerns. It only makes sense that they would be key players in improving access to healthcare services in rural areas.
Changes Under Consideration in Rural States
Because physician assistants make it easier for rural residents to be cared for in their own communities at a reasonable cost, many states are implementing changes that will make it easier for PAs to practice. For example, some states with large rural areas, like Idaho, are allowing more flexibility in delegation of service agreements between physician assistants and their supervising physicians. For example, rather than each physician being able to supervise three physician assistants, waivers can be obtained to allow them to supervise up to six.
Furthermore, physicians and physician assistants now have more flexibility to determine exactly how “supervision” is defined and which medical tasks may be delegated to PAs. In some states, physician assistants are limited in the medications they can prescribe, and some states are reviewing these rules to allow rural practicing physician assistants to, for instance, be allowed to prescribe category 2 through 5 controlled substances. All these steps may help ease the effects of physician shortages in rural areas.
The Takeaway for Physician Assistants
With the need for thousands of primary care providers over the next decade, and with the aging of America’s rural population, physician assistants will be on the front lines helping address the need for rural access to healthcare services. Many states are expanding the scope of practice for PAs, since outcomes and patient satisfaction scores are generally high with these advanced-practice providers.
It may take time for rural areas to find the right balance between use of physicians and physician assistants in addressing rural healthcare needs, but it’s clear that physician assistants play a critical role.
