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Education: Higher Education

The Physician Assistant Profession: Reflections on Its Past, Present, and Future

Class 5: Possible Contributions of Physician Assistants and Other Formally Trained Practitioners to the Provision of Health Care in the Future

Introduction

The relentless growth in demand for and cost of medical care will continue to stress the United States health care system for the foreseeable future. The demand for health care providers already outstrips their availability in most specialties, particularly in primary care and care of the elderly. As the Affordable Care Act and future legislation create pressure for improving efficiency and lowering costs without sacrificing quality, physician assistants (PAs) and nurse practitioners will play a growing role in innovative health care delivery. New roles for health care teams for high-risk and underserved populations are emerging in order to decrease unnecessary utilization of services and to give greater emphasis on prevention and health promotion. The teams include community health workers, who are a rapidly growing component of the health care workforce in the United States.

However, not all innovations in health care delivery are bound for success. For example, the Registered Care Technician proposed by the American Medical Association (AMA) proved to be highly controversial, and the AMA abandoned it as a strategy.

Suggested class outline:

  1. Current and future implications of the Affordable Care Act (the roots of effective PA and nurse practitioner utilization were included in the Clinton administration’s failed Health Security Act of 1992, and with the Primary Care Medical Home initiative, the utilization of these providers has increased)
  2. The changing roles of physicians in health care and the growing role of health teams in health care provision (younger physicians have often trained with PAs and are more willing to delegate medical duties to PAs and to employ them)
  3. The continued evolution in the “orchestration” of health care delivery and the “co-production” of medical “work” within and outside of the hospital, as well as how change evolves in the health professions
  4. The growing role of “out-of-hospital” care for patients with serious, chronic conditions
  5. The growing demands of cost restraint and high quality at lower cost, along with clear proof of PA cost-effectiveness in a wide variety of clinical settings
  6. Changes in patterns of palliative and end of life care brought about by emerging trends in state legislation.
  7. The emergence of community health workers as vital members of the health care team in the United States
Class Resources
Core resources
Supplemental resources
  • Boucher, N. A., M. A. McMillen, and J. S. Gould. “Agents for Change: Nonphysician Medical Providers and Health Care Quality.” Permanente Journal 19, no. 1 (Winter 2015): 90–93. doi:10.7812/TPP/14–095.
  • Cawley, J. F. “Physician Assistants and Title VII Support.” Academic Medicine: Journal of the Association of American Medical Colleges 83, no. 11 (2008): 1049–1056. doi:10.1097/ACM.0b013e3181890533.
  • “Certified PAs Do That!” National Commission on Certification of Physician Assistants. http://www.nccpa.net/pas-do-that (accessed 10/7/2016).
  • Cockerham, W. C., and B. P. Hinote. “PAs in a Changing Society: A Sociologic Perspective.” Journal of the American Academy of Physician Assistants 28, no. 8 (August 2015): 18–20.
  • Ku, L., et al. “Primary Care. Community Health Centers Employ Diverse Staffing Patterns, Which Can Provide Productivity Lessons For Medical Practices.” Health Affairs 34, no. 1 (2015): 94–103. doi:10.1377/hlthaff.2014.0098.
  • Quella, A., D. M. Brock, and R. S. Hooker. “Physician Assistant Wages and Employment, 2000-2025.” Journal of the American Academy of Physician Assistants 28, no. 6 (2015): 56–58. doi:10.1097/01.JAA.0000465222.98395.0c.
  • Schneller, E. S., and J. B. Ott. “Contemporary Models of Change in the Health Professions.” Hospital and Health Services Administration 41, no. 1 (Spring 1996): 121–136.
  • Schneller, E. S., and N. A. Wilson. “Professionalism in 21st Century Professional Practice: Autonomy and Accountability in Orthopaedic surgery.” Clinical Orthopaedics and Related Research 467, no. 10 (2009): 2561–2569. doi:10.1007/s11999-009-0836-4.
  • Schneller, E. S., M. Wallace, and M. Fertig. “Unsystematic Responses to a Chaotic Service Environment: Shaping the Division of Labour in Patient Care.” In Managing Change in the Public Services, edited by M. Wallace, M. Fertig, and E. Schneller. 153–172. Hoboken, NJ: Wiley-Blackwell, 2007.
  • “State of the American Health Care System.” C-SPAN Steve Scully interview of Dr. Atul Grover, Chief Officer, Association of American Medical Colleges video (43:38), August 5, 2012. http://www.c-span.org/video/?307453-4/state-american-health-care-system (accessed 10/7/2016).
Discussion Questions
  1. Given the changes in scope of practice and movement away from the use of the term “supervision of PAs’ to “collaboration,” should PAs become autonomous providers of health care services, like their counterparts in nursing? Is there a new paradigm that should be considered for autonomy when services are delivered by a health care team?
  2. Are there emerging health care roles for whom PAs and NPs might serve as “supervisors?”
  3. What roles can health care providers such as PAs play in population health initiatives that address multi-sectoral determinants of health and that require partnerships outside of clinical medicine (such as the public health sector, the education sector, the business sector, and the local government/social services sector), to influence health more broadly?
  4. Why are many hospitals and health care systems in the United States now investing in community health workers?
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