Legislature Increases the Role of Physician Assistants
Now physician assistants can be supervised by a panel of physicians that are regulated by the Oregon Medical Board
January 20, 2011 -- Physician assistants (PAs) can now play a larger role in primary care, thanks to legislation passed during the 2010 legislative special session (House Bill 3642), which is being heralded by physicians and the co-founder of a Portland chain of neighborhood healthcare clinics.
The new law signed by Governor Kulongoski allows PAs to be collectively advised and supervised by a panel of physicians that is in turn regulated by the Oregon Medical Board. This change, in theory, allows both physicians and PAs more flexibility in providing care.
Previously, Oregon statute established a ratio of one physician to four physician assistants, a method that proved impractical and problematic in practice because physicians had fewer PAs to help provide patient care, and had trouble getting hired because their presence exceeded that ratio.
Dr. David Sanders, co-founder of ZoomCare, a growing chain of “healthcare on demand” walk-in clinics in Portland and nearby suburbs, was among the key stakeholders behind the new law, and said it’s “having a positive impact on our ability to serve patients.”
Specifically, the bill allows physician assistants to play a larger role in providing “front line” primary care while allowing physicians to work as a team to collectively supervise them.
The bill also does away with a requirement that a physician must review a particular PA’s charts, which made it difficult for physicians to arrange for alternate PA supervision when they went to conferences or on vacation. In the new model, any physician on the supervising panel can review charts, allowing for a smoother workflow and less of a hassle.
In his testimony, Sanders said the bill would “improve performance while enabling physician assistants to contribute more fully to solving our grave primary care clinician shortage.”
Whereas a year ago a ZoomCare clinic with two physicians could only have eight PAs on staff, that same clinic can now have as many PAs as the clinic needs to handle patient demands.
This less restrictive approach was designed to help professionals take care of more people, but some skeptics raised concerns about the impact on patient safety. After all, if the PA-to-physician ratio increased, wouldn’t that imply PAs were being less rigorously supervised?
A requirement was added, by the Oregon Medical Association and other key stakeholders, to ensure that each PA have a supervising physician who would be on-call to answer questions, and serve as a mentor and advisor.
This was an essential part of the bill, according to Dr. Fran Biagioli, who sits on the OMA’s Executive Board and directs the PA Medical Program at Oregon Health & Science University. “If someone wasn’t named as the ultimate person a PA goes to, things would slip through the cracks a little,” said Biagioli. “That relationship and accountability is important.”
Biagioli is currently that “ultimate person” for a PA, and said the relationship works well. “My PA knows she can page or call me with questions anytime. But for smaller issues, or when I’m away, she can consult the [supervising physicians] panel.”
Although the bill passed unanimously in the House, four Senators opposed it, among them, Sen. Chris Telfer (R-Bend), who said cost was her chief concern.
“This bill came up at a time period when everyone was saying, ‘no new programs, no new money’”, said Telfer. “This was going to require new personnel for the Board; there were expenses to redo computer systems for this new model.”
Roughly $67,000 was allotted this biennium for a part-time staffer to assist with data entry for the Oregon Medical Board. Next biennium, that figure increases to slightly more than $100,000.
Sen. Laurie Monnes Anderson (D-Gresham), is an outspoken proponent of the new law. “Any kind of change is very difficult for any Board, and I wish they could become a bit more flexible.” As to why she was supportive, the physician panel “made much more sense,” she said, than the previous model.
Meanwhile, the solutions to Oregon’s healthcare crisis “all hinge on a continued improvement around workforce issues,” according to Sanders, who called this endeavor a good start.
Jan 20 2011