Much of American health care's future can be seen in two synergistic kinds of services in tiny, urban Rhode Island.
One is Federally Qualified Health Centers (FQHCs). These facilities, set up around America, provide a wide range of free and insurance-subsidized clinical help for millions of patients, most of them low-income.
The other is the burgeoning field of physician assistant education. Here I look at Johnson & Wales University's spanking new Center for Physician Assistant Studies, in Providence. There are other such training centers cropping up around America. Indeed, Bryant University, in a Providence suburb, has a highly regarded one.
Consider the state's biggest FQHC organization -- Providence Community Health Centers (PCHC). Its teams of physicians and other clinicians, such as nurses and nurse practitioners, work for what is the biggest single provider of primary-care services in Providence, with more than 35,000 patients. (I toured PCHC's immaculate Prairie Avenue campus the other week, led by Merrill Thomas, its CEO, and Jane Hayward, the Rhode Island Health Center Association's president.)
PCHC 's mission, it says, is to "provide neighborhood-based high quality and accessible primary medical care to improve the health status of the residents of Providence and surrounding communities regardless of their ability to pay.'' FQHCs play especially important roles in inner cities and impoverished rural areas, such as Appalachia, where many physicians don't want to practice, especially because of low reimbursement and so many difficult cases involving seemingly intractable behavioral-health issues.
Expanding primary care -- especially preventive care -- is essential if America is to improve overall health outcomes that are near the bottom of the Developed World while better controlling medical costs, which are the highest.
Whatever happens with the Affordable Care Act, the U.S. population's aging (older means sicker); the daunting complexity of our health-insurance system; the permanent exit of many well-paying jobs; emigration to the United States of low-income people, and the decline of the stable, two-resident-parent family suggest that Federally Qualified Health Centers ought to play even bigger roles.
Of course, increasing the numbers of primary-care clinicians is essential for the long-term success of these clinics. Doing just that is the Johnson & Wales Center for Physician Assistant Studies, which has a beautiful building in Providence's Jewelry District.
Its 24-month master's program addresses the need to train many more non-physician clinicians who can perform highly professionally and cost-effectively some of the tasks now performed by over-worked (if highly paid) doctors. PAs are especially useful in getting patients to make the behavioral changes needed to prevent serious illness, in part because they can generally spend more time with patients than can physicians; many of the latter are more harried than ever because of onerous electronic-health-record duties and administrative pressures to boost patient volume.
J&W notes that PAs work in integrated medical teams to "provide diagnostic, therapeutic and preventive health-care services.'' (By the way, the differences between physician assistants and nurse practitioners mostly involve some education details. They're very similar professions.
With physicians as supervisors, physician assistants take patients' histories and perform exams; order lab tests; prescribe medications; diagnose illnesses; develop treatment plans, and counsel and educate patients.
No wonder that demand for PAs is surging. Forbes.com has listed Physician Assistant Studies as the "No. 1 Best Master's Degree for Jobs.''
The American Academy of Physician Assistants (AAPA.org) says that "demand for physician assistants and nurse practitioners rose by more than 300 percent in the last three years.''
We'll need PAs in droves in coming years as, technology, demographics and new cost controls continue to transform U.S. health care for all patients, especially in primary care, in which physician assistants will be at the forefront.
Last week we cruised the gorgeous Upper Connecticut River on a pontoon boat. Because it's by far New England's biggest river, on it you get a sense of what Mark Twain might have felt on the Mississippi. We yakked desultorily in the soft breeze about big projects we'd do - as if we were 30 years younger than we are.
Robert Whitcomb (rwhitcomb51@gmail.com), a former editor of these pages, is a partner in Cambridge Management Group , a healthcare-sector consultancy, a Fellow of the Pell Center for International Relations and Public Policy, a former Providence Journal editorial-page editor and a former finance editor of the International Herald Tribune.