“Busting Myths” about Physician Assistants
By: Frances Feudale DO, FACEP, Program Director, King’s College Department of PA Studies
As an osteopathic physician member of the PSPA, I recently received an email from Mark DeSantis, PA-C Chairman of the PSPA Governmental Affairs Division asking me to write a letter to the State Board of Osteopathic Medicine in support of allowing prescriptive authority to PAs who work under the supervision of a DO. I felt very compelled to address this issue and decided to contact other osteopathic physicians and medical students that I knew personally to encourage them to also write letters in support of this cause. Although I received many positive responses, I was very surprised at the negative responses I received particularly because the reasons given were based on misconceptions about physician assistants and their scope of practice. I was unable to just allow these misconceptions to perpetuate and grow into “urban myths”, so I have decided to address these issues and be armed with the facts so that these myths can be “busted.”
Myth: The Pennsylvania State Board of Osteopathic Medicine does not support prescriptive authority for physician assistants.
Fact: In the past, there has certainly been resistance by the Osteopathic State Board to allow PAs prescriptive authority under the supervision of a DO. However, as early as 1978, the Osteopathic Medical Act directed the Osteopathic Board to develop regulations allowing delegated prescriptive authority under supervision. Unfortunately, the Board has never taken the steps to develop that language. In 2005, the Osteopathic Board voted in favor of allowing NP’s prescriptive authority that they previously prohibited which shows a change in the minds of board members regarding privileges for mid-level practitioners (1). In fact, there are currently several members of the Pennsylvania Osteopathic Board, including the Board Chairman, who make it known that they do not agree with the current policy of denying prescribing rights for PAs.
Myth: Physician assistants do not have adequate education and training to allow them to safely prescribe medications.
Fact: The first Physician Assistant Program was started by a physician at Duke University, who modeled physician assistant education after the same curriculum that his medical students received (2). In those early years, most of the students were medics, nurses or other types of healthcare professionals with many hours of education and experience. Today, most PA programs require applicants to have a number of healthcare experience hours as a prerequisite for admission and thus students often have had previous medical training or experience (3). In order to produce competent physician assistants, the ARC-PA standards require that “programs … prepare students for prescriptive practice” and pharmacology must be included in a PA student’s basic medical science instruction (4). On average, PA programs require about 80 hours of formal classroom instruction in pharmacology and students average over 300 hours of pharmacology instruction during their clinical clerkships. Finally, a PA’s knowledge of pharmacotherapeutics is tested on the national certification exam and retested every six years (5). Therefore, physician assistants graduating from accredited programs receive the appropriate instruction and clinical training necessary to allow them to safely write prescriptions under the supervision of a physician.
Myth: Allowing PAs to prescribe in any capacity would constitute harm to the general public.
Fact: Information from the National Practitioner Data Bank (NPDB) reveals that PAs incur a remarkably low rate of malpractice judgments. Moreover, other data support the possibility that hiring a PA may actually reduce the risk of malpractice liability (6). In fact, research shows that there is no increased liability as a result of physicians utilizing physician assistants in their practices (7). In addition, numerous studies have shown that the quality of care given by physician assistants is at the level of that given by physicians (8).
Myth: PAs want to be autonomous and take over the physician’s role.
Fact: Quite the contrary! The PA profession remains committed to the concept of the supervising physician-PA team. This is reflected in the AAPA’s description of the profession: “Physician assistants are health professionals licensed or, in the case of those employed by the federal government, credentialed, to practice medicine with physician supervision” (9).
Myth: There is no data to support that PAs are capable of filling some “perceived void” in healthcare delivery.
Fact: “With our nation facing new health challenges and a possible physician shortage, the apparent flagging interest in the medical profession as reflected by the shrinking [medical school] applicant pool over the last several years has been cause for some concern,” said AAMC President Jordan J. Cohen, M.D. (10). According to the American College of Physicians “During the next decade, generalist physicians alone cannot meet the anticipated gap in primary care services. Nurse practitioners and physician assistants will have a key, complementary role in filling this need. We are committed to supporting these collaborative practice arrangements. The College supports expanded roles for nurse