Are physician assistants taking over health care?

When you make an appointment with a physician, it’s becoming more and more likely that you will be seen, not by an MD, but by a physician assistant (PA). These medically trained, licensed professionals expand a doctor’s capacity to care for their patients.

The field is growing, but PAs are nowhere close in number to MDs. There are about 1.1 million doctors in the U.S., while the number of physician assistants is around 160,000. The trendlines tell a different story, though.

The number of certified PAs grew by 28% from 2018 to 2022, according to the National Commission on Certification of Physician Assistants (NCCPA). Meanwhile, according to a report from the Milbank Memorial Fund, one in three U.S. doctors practices primary care, but among doctors two years into their careers, the share is only one in five. The Association of American Medical Colleges projects we will be short as many as 48,000 primary care doctors by 2034.

So, as it’s clear that PAs will be playing an ever larger role in primary, and even specialty, care, it’s important for we patients to understand their role.

How do the educations of PAs and MDs compare?

The path to both health care roles begins with a four-year college degree. Aspiring physician assistants then attend a two- to three-year PA program, while aspiring doctors attend medical school for four years, followed by internships, residencies and even more years of education in a medical specialty.

A PA fresh out of school has a minimum of 2,000 clinical hours under their belt. Because many PA programs require prior health care work as a prerequisite, many of these professionals come to the workforce with substantial clinical experience.

Advanced education and training, along with fellowships and residencies, are required if a PA specializes. Common specialties include cardiology, dermatology, surgery, emergency medicine and obstetrics.

When I make a doctor appointment, should I be notified in advance if I will be seen by a PA?

Yes, in most places, it's standard practice for health care providers, including doctors' offices, to inform patients if they will be seen by PA instead of a physician. But I know from experience that this isn’t always the case.

If you’re expecting your doctor and a PA walks in, you have two choices: Decline to be treated and reschedule, or agree to be seen by the PA. For routine appointments and most illnesses and injuries, a PA and an MD will likely not differ in their diagnosis and care plan.

When surgery is needed, or the patient has a rare, complex or specialized condition, doctors, surgeons and board-certified specialists are trained to provide more thorough and knowledgeable care.

Do PAs have to identify themselves?

Yes, in Illinois and most states, physician assistants are required to introduce themselves as PAs. If you’re unfamiliar with the person, feel free to ask, “And are you a PA or an MD?”

Can a PA practice independently?

Yes, but only in North Dakota, Utah and Wyoming. Everywhere else, including Illinois, a PA must be associated with a medical practice.

There have been some changes, however, in the relationship between PAs and physicians. Legislation passed in 2017 in Illinois states that PAs are considered to be working “in collaboration with” not “under the supervision of” physicians. The American Academy of Physician Assistants a few years ago decided that PAs should more appropriately be called “physician associates” rather than assistants.

Do PAs cost less than MDs?

The answer to this question depends on whether you’re the medical practice, the insurer or the patient.

If you’re the patient, your co-pay will probably be the same. But because a PA’s salary is about half that of a physician, the medical practice may allot a longer appointment with a physician assistant than with the physician. Patients often say that their PA took more time with them to listen and explain, and they didn’t feel rushed out the door.

Insurance providers often reimburse medical practices at a lower rate when the patient is seen by a PA because the PA is a less costly employee, not because the care is inferior.

In a future column, I’ll talk about the role of nurse practitioner — another medical practitioner who helps medical care reach more people.

The bottom line with PAs is this: You have every right to see who you want to see. It just may take longer to get an appointment.

• Teri (Dreher) Frykenberg is a board-certified patient advocate. A critical care registered nurse for 30+ years, she is founder of NShore Patient Advocates (www.NorthShoreRN.com). Her book, “How to Be a Healthcare Advocate for Yourself & Your Loved Ones,” is available on Amazon. She is offering a free phone consultation to Daily Herald readers; email her at teri@northshorern.com.