Opinion: Physicians oppose Alaska Senate Bill 115 — Independent Practice for PAs

Alaskans don’t want access to just any health care, they want access to high quality care

Health care today is more complex and complicated than ever before. Rapidly evolving science and technology mean that we have more options than ever for diagnosing and treating many diseases. This complexity means that quality health care increasingly relies on teams of professionals.

Physician assistants (PAs) and nurse practitioners, collectively known as Advanced Practice Providers (APPs), have become indispensable members of the health care team, working in close collaboration with medical doctors and doctors of osteopathy to deliver quality care.

While PAs play a critical role in the delivery of health care and are highly valued partners, the current Alaska Senate Bill 115, which would grant independent practice to PAs, raises several issues of concern. Independent PA practice without physician supervision has implications for patient safety, quality of care and the cost of health care in Alaska.

The most serious concern is the potential impact on patient safety and quality of care. Multiple studies have shown that when APPs operate independently, there is an increase in unnecessary testing, specialty consultations, emergency department visits and hospitalizations. This drives up health care costs and reduces access to specialty and emergency care for everyone.

The differences in PA practice are not surprising given the vast difference in education and training compared with physicians. Physicians complete four years of medical school followed by three to 10 years of residency and fellowship training.

Residents and fellows spend up to 80 hours a week in intensive direct patient care responsibilities, usually in large academic medical centers. Residency programs have a rigorous curriculum and designated numbers of supervised procedures required in order to graduate.

The training and curriculum are fundamentally different for PAs, who complete two years of school prior to clinical practice with no required residency or other additional clinical training. Just as a paralegal wishing to become a lawyer or a drafter wanting to become an engineer would need additional schooling and training, PAs have the option of pursuing additional training through medical school.

Some of the arguments for independent PA practice include a shortage of health care providers in rural areas. Alaskans don’t want access to just any health care, they want access to high quality care. PAs operating in collaboration with physicians as was originally envisioned and intended are critical to helping achieve this goal.

Other arguments include the onerous financial and regulatory requirements for PAs to retain physician sponsors. This process is outdated, in need of reform and should be revisited.

ASMA is prepared to support a multidisciplinary task force of physicians, PAs and regulators to write better rules. Radical change in health care policy, rushed through at the end of the legislative session, is not the solution to these problems.

Given these concerns, the Alaska State Medical Association, the Alaska Academy of Family Physicians, the Alaska Chapter of the American College of Physicians and the Alaska Chapter of the American College of Emergency Physicians oppose S.B. 115 as written.

Kristin Mitchell MD, FACP, is president of the Alaska State Medical Association and lives in Soldotna.