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New law allows physician assistants more freedom

An AP Member Exchange from The St. Louis Post-Dispatch

By MICHELE MUNZ

The St. Louis Post-Dispatch

ST. LOUIS (AP) — Supporting the theme parks and attractions in the tourism hub of Branson, Mo., are thousands of hourly workers manning the ticket counters, cleaning hotel rooms and waiting on tables.

These residents, living among the Ozark Mountains in Taney and Stone counties, often lack health insurance. Three years ago, a group of volunteers opened a clinic in a donated building with donated medical equipment to care for them.

“It was just a matter of us saying we wanted to provide this for our community because we thought it was the right thing to do,” said Rick Tallon, who volunteers as a dentist at the clinic.

But for the past two months, the Faith Community Health clinic has been idle. Trying to provide care with busy physician volunteers has been unreliable and sporadic, Tallon said. “We have 500-plus patients on the waiting list.”

A new Missouri law providing more freedom for physician assistants to care for patients could change that. Advocates hope the change will alleviate the shortage of primary care doctors in Branson and across the state — a shortage expected to worsen as the Affordable Care Act expands health care benefits to millions more Americans, the St. Louis Post-Dispatch reported (http://bit.ly/13dFcav ).

Currently, physician assistants must be supervised by a doctor located within 30 miles of where they practice, and a doctor must be present 66 percent of the time they are caring for patients — the second-most restrictive state law in the country.

That will change Aug. 28 when the supervising doctor will be allowed to be up to 50 miles away and will have to spend only half of a day on site for every 14 days the physician assistant practices.

Easing restrictions on physician assistants, who have more than two years of postgraduate study, is lauded as an affordable way to improve care for residents who are geographically isolated or see long waits at understaffed clinics.

“Allowing physician-PA teams to tailor medical care according to the needs of their patients and communities can only lead to better access to care in rural and underserved areas,” said Paul Winter, a physician assistant at Missouri Baptist Hospital and president of the Missouri Academy of Physician Assistants.

The legislation is breathing life into the struggling Faith clinic in Branson, which plans to use grants from the Missouri Foundation for Health and the CoxHealth Foundation to pay a physician assistant to staff the clinic full time.

“This is going to give us the opportunity to have someone in there who can take care of a high number of patients without having to have a physician there” two-thirds of the time, said Tallon, who also serves as the clinic’s board chairman.

Physician assistants can perform physical examinations, diagnose and treat illnesses, order and interpret lab tests, prescribe most medications, perform procedures, assist in surgery, and provide patient education and counseling. The supervising doctor outlines their duties based on experience and skills. They are nationally certified and state-licensed.

Physician assistants have a bachelor’s degree and complete a physician assistant training program, which averages 27 months and includes 2,000 hours of clinical work in different specialties such as pediatrics and psychiatry. Primary care doctors have more than 15,000 hours of clinical training.

The Missouri State Medical Association, along with other state doctors’ groups, supported easing supervision on physician assistants.

“We need to be able to get high quality medical care to these remote areas with a low volume of patients and no doctors,” said Dr. Stevan Whitt, chief medical officer for the University of Missouri Health System, who testified in favor of the law. Physician assistants can staff satellite clinics, make house calls, visit nursing homes or make hospital rounds.

By 2015, the Association of American Medical Colleges predicts a national shortage of 33,100 primary care physicians because medical students are choosing other specialties with better pay and hours, and older primary care physicians are retiring.

These much-needed providers, however, leave Missouri in droves. The state has two physician assistants training programs: at St. Louis University and Missouri State University in Springfield. Half of the graduates go to states with fewer restrictions and more jobs, university officials say.

Missouri has only 11 physician assistants per 100,000 residents, compared to the U.S. rate of 24, according to a recent report by the Missouri Foundation for Health, an independent philanthropy working to improve access to health care. Only three states have lower rates.

“That’s just fewer providers overall to take care of Missouri residents,” said Caroline Chang, an assistant professor in SLU’s department of physician assistant education. “We’re hoping that this new legislation is going to vastly improve that problem in our state.”

In urban areas, clinics serving the uninsured and Medicaid patients have a hard time attracting primary care doctors because of the pay.

Dr. Robert Taxman works with two physician assistants at an urgent care center on Delmar Boulevard operated by St. Louis ConnectCare, a network of specialty providers serving those lacking insurance. He sees hiring more physician assistants as an affordable solution to treating a patient population that has doubled over the past few months.

“We see the trend as only likely to increase over time. The more patients you have, the more caregivers you need to take care of them, and when the physician is overloaded, the quality of care drops,” Taxman said.

Physician groups, however, have not always been supportive of easing restrictions on physician assistants. Doctors are feeling pressure from the Affordable Care Act, which stresses prevention and better management of chronic diseases such as diabetes and heart disease through a team approach. Reimbursements to hospitals will be based on health outcomes.

“Our regional health care system will be penalized for not doing things to keep people healthier .,” said Whitt with the University of Missouri Health System. “Your job is also to take care of them before getting sick, which most people think is ideal, but it is hard. So you must take care of people at their site, at their home or in their town . as opposed to our current system, where you come to us in our urban centers.”

Physician assistants are ideal for that, he said, especially with the latest advancements in telecommunication. Doctors can easily collaborate with physician assistants and advance practice nurses in remote areas from their office.

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Information from: St. Louis Post-Dispatch, http://www.stltoday.com

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