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This piece was originally published in the Feb. 22, 2010 edition of the Lexington Herald-Leader newspaper.

Expand health care by loosening curbs on usefulness of PAs

At issue – Feb. 7 Herald-Leader article "Where's a cure for state's medical gap? Nurse practitioners say they can be partial cure"

By Lori S. Gonzalez and Doris Rapp

The physician shortage in Kentucky is a complex problem that requires a multi-faceted solution.

Without a significant increase in resources, the state's medical schools cannot educate enough physicians to meet its health care needs, and the proposed health care reforms could put further strain on the system.

Both physician assistants and nurse practitioners, as mid-level practitioners, play different roles in health care and are an important part of the solution to this shortage.

Physician assistants (PAs) are professionally trained to extend, not replace, a physician's reach. In fact, the American Academy of Physician Assistants estimates that a physician assistant can expand a physician's practice by one-third.

This means that by working in collaboration with a PA, 33 percent more patients could receive consistent, high quality care by a physician-led physician-PA team practice than could be cared for by a physician alone.

This is just one way collaboration can provide Kentucky patients with the quality health care services they need.

Since the physician assistant profession was established more than 40 years ago, the AAPA has remained committed to the physician-PA team approach, stating, "PAs improve patient flow by freeing up physicians to manage more complex or demanding cases."

An American Medical Association survey found that PAs enhance practice efficiency, and solo practice physicians who employ PAs experience expanded practice, greater efficiency, and greater access to care for their patients.

As Kentucky's health care divide increases, this team approach will be necessary for meeting the health care demands of our state, especially those that are universally underserved.

The physician assistant program at the University of Kentucky, for example, has a campus in Morehead, focused on training students so they can return to rural areas of the state to provide quality health care.

This collaborative program has been in existence for 12 years. In addition, all physician assistant students complete clinical rotations in rural areas across the state, giving them insight into our most critical health care needs.

The solution to the physician shortage not only involves training more practitioners, but also requires finding ways to keep Kentucky-trained practitioners in the state, especially rural areas of the state.

Current PA practice laws challenge physician-PA teams from meeting the needs of the patients they serve by restricting the ability of PAs to practice at the level deemed appropriate by their physician supervisors.

These same laws are particularly restrictive for new graduates of Kentucky's physician assistant programs. The citizens of the commonwealth most affected by these restrictions are those in most urgent need of health care providers: rural and other under-served populations.

A bill being debated in Frankfort, House Bill 358, seeks to improve the ability of physicians to use the experience and capabilities of physician assistants to maximize their impact on the health and well being of their patients.

This bill has five elements to support a physician's ability to utilize Kentucky-trained physician assistants. It allows:

  • Privileges to prescribe scheduled medications.
  • Physicians to decide how many PAs they will supervise.
  • Physicians to decide how closely to monitor PAs' patient records.
  • Lowering the amount of time a physician must directly supervise a PA after graduation from an accredited PA program.
  • PAs to provide emergency-disaster aid without first seeking permission from state regulators.

Each of these changes to PA practice law would be controlled by the individual who best understands the PAs' skills and capabilities: the supervising physician.

As stated in the article, Kentucky needs more than 2,200 additional physicians to meet the national standards. Our educational system simply isn't able to meet these demands – especially with growing debt and state educational cuts.

However, by working together, physician assistants, physicians and other health care professionals can become more efficient, lower costs and play a role in addressing what is most important – the care of Kentucky's patients.

If these pieces come together – greater understanding of a mid-level practitioner's role in health care, state law that's favorable to retaining Kentucky-trained practitioners and educational support to train more practitioners – Kentucky will be on its way to closing the gap in the health care shortage.

Lori S. Gonzalez is a tenured faculty member and dean of the University of Kentucky College of Health Sciences.

Doris Rapp is a tenured faculty member and division director of the Physician Assistant Studies program at UK.

For more information about the Physician Assistant Studies program, visit