Over the course of posting interview with various health figures, many commenters have asked about the
role of non-physician providers, both in terms of scope and cost. When writing up the nomination of Dr. Regina Benjamin for Surgeon General, I learned that she, like myself, works with a health team that includes physician assistants. And given that the PA that I work with was recently elected to the position of president-elect of the American Academy of Physician Assistants, this seemed like an opportune time to explore another dimension of health care.
Patrick E. Killeen MS, PA-C currently serves as the president elect of the American Academy of Physician Assistants (AAPA). He has held an active role within AAPA for more 22 years as a board member and participant of the House of Delegates, Medical Congress and strategic relations workgroup. He also has served as a peer reviewer and liaison coordinator for AAPA. Killeen earned a BS in human development and family studies with a concentration in early childhood education from Colorado State University. He is certified as a child life specialist from John Hopkins University and earned his MS as a child health associate and certified PA from the University of Colorado Health Science Center. I’ve known Patrick for a decade and a half, and am delighted to have him as an interviewee.
Daily Kos: Patrick, thanks for taking some time for this interview. One of the key components of health reform involves cost control, and one way to control costs is to more expansively use non-physician providers such as Physician Assistants and Advance Practice Nurses. Does the AAPA have a position about health reform, and in particular the role PAs can play?
Physician assistants (PAs) are an integral part of health care reform. PAs are primary care providers and work in all medical and surgical specialties and settings as part of physician-PA teams. PAs practice medicine in a team-based model of care with physician supervision.
PAs control health care cost by:
• Participating in the provision of preventive care, management of long term and chronic conditions and in patient education. The most cost effective treatment of any disease is prevention.
• Helping to assure that patients are seen at the right time, in the right setting by the right provider. Every time a patient who could be seen in a primary care setting is seen in an emergency department it is an unnecessary cost for the system, and unnecessary stress for the patient.
• PAs can help decrease waiting time and efficiency in practices, making the physician’s time and talents used more cost effectively. This also helps patients get appointments more readily – something that can help assure that conditions are treated in their early stages, before more traumatic and costly treatments are required.
• The profession’s affordable salaries (averaging about $89,000 per year across all specialties) make PAs an attractive choice for increasing the volume of providers within the medical system at a fraction of the cost. Because of their generalist medical training, PAs often deliver or supplement primary and preventative care even if they work in specialties. It is not uncommon for PAs in oncology to see survivors for years after their cancer has been treated and the routine, diligent monitoring of the patients’ health often uncovers other issues such as diabetes or heart disease.
• We’re continuing to learn more about how PAs deliver care and whether or not they skew toward quality of care or quantity of care. Recently, Perri Morgan, PhD, PA-C, director of Physician Assistant Research at the Duke University Medical Center, examined PA cost-efficiency by asking whether they increase the availability of the services offered by physicians or instead provide additional care that actually increases the number of visits that a patient uses. Morgan and her colleagues concluded that, on average, PAs are replacing care that would be provided by physicians rather than offering additional or redundant services to patients. The research showed that when PAs provided 30 percent or more of a patient’s office visits in a year, there was no increase in the total number of office visits per year.
Daily Kos: Numbers! Let’s have some numbers about the profession. is there growth ahead for PAs?
• The American Academy of Physician Assistants (AAPA) estimates there were 85,345 people eligible to practice as PAs and 73,893 people in clinical practice as PAs at the beginning of 2009
• Approximately 257 million patient visits were made to physician assistants in 2008.
• Approximately 332 million medications were prescribed or recommended by PAs in 2008.
• All 50 states, the District of Columbia, and Guam authorize PAs to prescribe.
• The United States Bureau of Labor Statistics (BLS) projects that the number of PA jobs will increase by 27 percent between 2006 and 2016. The BLS predicts the total number of jobs in the country will grow by 10 percent over this 10-year period. The PA profession was ranked the fourth fastest growing profession in the country by CNN.com and Forbes.com in 2007.
Daily Kos: As it happens, you and I have worked as a team for many years, and I recently became aware that the new Surgeon General nominee, Dr. Regina Benjamin, works as a team with PAs in her clinic in Alabama. Can you tell me anything about that partnership from the PAs perspective?
Dr. Benjamin is an advocate for care to the underserved, primary care, elimination of health disparities and of using creative options to provide care to difficult to serve populations. These values are shared by the PA profession. Dr. Benjamin has seen the value of the physician-PA team personally in her clinic, the La Batre Rural Health Clinic. Currently, she employs and works closely with a PA who is an AAPA member.
Dr. Benjamin is also a friend to the PA profession and the AAPA. Most recently, Benjamin was featured as a keynote speaker at a February 2009 AAPA conference for constituent organization leaders during her tenure as Chair of the Federation of State Medical Boards in 2008-2009. She spoke about the physician-PA team, the important roles of professional organizations working together, the initiatives of the Federation that were important to PAs and PA practice, and the work to be done by all health professionals to assure access to care and the elimination of disparities of all kinds.
We think she will be a true leader as the nation’s surgeon general.
Daily Kos: Does the AAPA have a position on the public option currently being discussed in Congress as part of health reform?
AAPA policy does not speak specifically to the public plan option that is currently being considered by Congress. AAPA policy does, however, address the need to provide access to quality, affordable, cost-effective health care to all Americans. AAPA will certainly evaluate the various health care reform proposals by their ability to fulfill that policy.
Daily Kos: Did the AAPA taken a position on CHIP (children’s health insurance program) or tobacco taxes and FDA regulation of tobacco?
AAPA strongly supported the reauthorization and expansion of the Children’s Health Insurance Program. Additionally, AAPA has strong policy encouraging PAs to strive to eliminate tobacco products from their personal lives and the lives of their patients and colleagues.
More specifically, on tobacco, the American Academy of Physician Assistants (AAPA) applauded the 111th Congress for enacting, and President Obama for signing into law, the “Family Smoking Prevention and Tobacco Control Act.”
The Act protects public health by granting the Food and Drug Administration (FDA) certain authority to regulate tobacco products. The regulation of tobacco products by the FDA is essential to AAPA’s goal to educate consumers and eliminate the use of tobacco products. AAPA encourages all PAs to be actively involved in community outreach that educates people of all ages about the dangers of smoking with the goal of eliminating tobacco use.
On CHIP, AAPA applauded the Congressional approval of the expansion of the Children’s Health Insurance Program (CHIP) on February 4. This move provides coverage for an additional four million children of working parents. Congressional action on the CHIP reauthorization is an important step forward, but more remains to be done. As evidenced in the recent Institute of Medicine (IOM) report, “America’s Uninsured Crisis: Consequences for Health and Health Care,” massive health care reform is imperative to improving the health care of those Americans who are uninsured and underinsured.
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