As a physician I realize that some may think I am being blasphemous by posting this position but, I often wonder, in some cases not all, why we as patients pay so much money for so little time with our physicians. As a matter of fact, it fascinates me that many doctors now relegate initial patient consultation to a PA (physician assistant). While I fully respect the role that a PA plays in the health and well being of patients, it infuriates me when I hear that PAs are handling patient visits, recommending treatment options and in some cases prescribing medication. I know that the supervising physician must approve any and all decisions, but whatever happened to the coveted doctor-patient relationship?
My issues with the increasing use of PAs revolve around the following detail outlined by the Bureau of Labor Statistics.
1. Physician assistant programs usually lasts at least two years; admission requirements vary by program, but many require at least two years of college and some health care experience. My physician colleagues and I completed four years of college and then four years of medical school, plus three to five years of residency as well as one to three years of fellowship in a specific subspecialty. Along the way, vigorous tests were mandated for assuring competency in addition to specialty board examinations, which are usually a two or more year process involving both written and oral testing. Is it right then to unleash a lesser trained healthcare professional onto a patient and expect that they will have the same insight that a trained and experienced physician will have? Will they be able to detect the subtle signs and symptoms of a condition or will they only see what they have been trained to identify and will the signs and symptoms need to be very obvious to be noted?
2. Employment is projected to grow much faster than average as health care establishments increasingly use physician assistants to contain costs.
Containing costs by turning diagnosis and treatment decisions over to lesser skilled medical practitioner could actually lead to higher costs. It might take more time for a PA to identify and determine treatment options for a condition than it may for a skilled physician with years of training and experience. More importantly, will a subtle finding be masked by a more obvious but less serious finding? Will a condition have to progress to the point of obvious before diagnosis can be determined and treatment can begin?
3. Job opportunities should be good, particularly in rural and inner-city clinics.
This is also unfortunate. Rural towns and inner city clinics need skilled physicians the most. The National Institutes of Health report that people in rural areas of the United States have higher rates of chronic disease. While the Urban Environment Foundation reports that the inner city is the most hazardous of residential environments and the resulting health problems of low income, urban minorities are compounded by inadequate access to medical care. Rural towns and inner city clinics need skilled physicians the most but these are the very areas most likely to employ PA's over MD's.
A PA can be an excellent adjunct to the physician patient relationship if he or she is used to assist in the overall healthcare process and not replace physicians altogether. The doctor should be the front line of defense for every patient that walks in and out of his or her office. As a patient you should never be embarrassed or hesitate to ask whether the person seeing you is a licensed physician or a PA.
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