22
doc • Winter 2016
Kentucky
Physician Assistants and
Health Care Delivery
By Tuyen Tran, M.D.
We have a healthcare
crisis in the United States.
The relative isolation of
consumers to direct cost
(government programs, private insurances)
has resulted in an unchecked increase in
demand. Expenditures are rising faster than
overall economic growth. Pricing mechanisms can no longer adequately ration health
resources. As such, the only remaining factor
which can ration the limited resources is
access, or unfortunately, inaccessibility to
timely care.
In March of 2015, the Association of
American Medical Colleges (AAMC)
reported that by 2025, the US will have an
estimated shortage of 12,000 – 31,000 primary care physicians and 28,000 – 63,000
non-primary care physicians, most significantly, surgical specialists.1 Of the multiple
proposed solutions offered, incorporation
of mid-level providers (physician assistants
and/or nurse practitioners) into the workforce is most appealing. Interestingly, leaders in healthcare met in 1965 to address a
similar pressing national concern – health
provider needs. The conference stimulated
the discussion, “[Could] physicians train
assistants to accept ever-increasing responsibility for appropriate decisions concerning
services provided to individual patients?”2
Bradford Schwarz, an active hospitalist Physician Assistant (PA), Associate
Professor and PA Program Director at the
University of Kentucky, responds, “There is
not a greater time than now for physicians
and physician assistants to lock arms and
unite together as team-based providers with
like minds, attitudes, and focus in providing the highest level of patient care possible
while maintaining our autonomy and collective bargaining power.” Schwarz elaborates,
the practice of medicine has changed. The
market place is driving a medical industrial
transformation. This is causing dramatic
changes in financial considerations, organi-
zational structure, and cultural traditions.
The traditional model of a physician-owned
practice where the physician assistants
were physician employees has rapidly transformed into hospital-owned groups where
both physicians and physician assistants are
employees, colleagues, and often members
of the same team.
It’s important to examine the inception of
the physician assistant profession. Although
many significant people contributed, Eugene
A. Stead, M.D., is credited with the founding of the physician assistant profession. He
drew from his experience of developing a
program to “fast-track” the training of doctors during World War II. After the war,
America experienced a tremendous shortage
of physicians. Dr. Stead, the chairman of
Duke University’s Department of Medicine,
attempted to establish an accredited clinical nursing program in 1950s and again in
1960s. Each time, the National League of
Nursing, reluctant to change the traditional
nursing role, thwarted his efforts. Dr. Stead
was forced to look elsewhere and he immediately identified his ideal candidates for
the intense two-year abbreviated medical
school – highly skilled medical corpsman
returning from Vietnam. And in 1965,
Duke University launched the first physician assistant program as a “strategy to help
over-extended physicians provide more
services…”
The physician assistant’s educational
requirements include a bachelor’s degree
and a varyi