By Surabhi Dangi-Garimella, Ph.D.
Here’s a grim statistic from the Association of American Medical Colleges (AAMC): by 2034, there will be an estimated shortage of 17,800-48,000 primary care and 21,000-77,100 specialty physicians in the U.S. Strategies to remove patient barriers to care will be amiss if this hard fact is disregarded. While census data indicate that the physician workforce grew by 20% between 2010 and 2020, a significant proportion of physicians are close to retirement or have exited early due to duress from the COVID-19 pandemic.
The bottom line is medical service providers need support, and rethinking existing norms might be a viable option.
Increasing the Independence of Physician Assistants
Legislators in the state of Montana are working toward changing the existing state legislation that requires a physician assistant (PA) to work under the supervision of a licensed physician and within the guardrails of a binding supervision agreement. Lawmakers are proposing to amend various sections within House Bill 313 to give licensed PAs the independence to practice without the need for a supervising physician or a supervision agreement.
New York state wants to make a permanent change to the education law that mandates a PA to work under a supervising physician. Assembly Bill A5012, currently in Committee, wants to make permanent the rules set in place during the pandemic: allow PAs to independently provide services without the direct supervision of a physician if they have practiced for more than 3,600 hours. While a designated physician will still be responsible for the PA, they do not have to be physically present when PAs provide medical services. The current state law allows PAs in primary care or non-surgical general medicine to provide treatment without oversight by a doctor only if they are employed by a health system or hospital and must have practiced for more than 8,000 hours.
In 2019, North Dakota was the first state to significantly change practice patterns for the state’s PAs, easing practice restrictions such as a written agreement with a physician, the need for supervision, or a physician being responsible for the care provided by a PA, among other things. In 2021, Wyoming signed legislation to change the way PAs could practice in that state, repealing the need for PAs to have a specific relationship with a physician or other provider to be able to practice, and expanding their authorized scope to practice.
Changes made by the Centers for Medicare and Medicaid Services to the 2020 Physician Fee Schedule deferred Medicare’s PA supervision requirements to the state laws. Other changes, including an executive order issued by the Trump Administration in 2018, were implemented to reduce administrative burden on PAs and increase their independence.
Making Medical Education Accessible
A different approach, spearheaded by Sen. Bernie Sanders, is to expand medical education and making efforts to increase student loan forgiveness. Drawing attention to the fact that medical school graduates often face steep medical debts, Sen. Sanders emphasized that medical students who are ready to join the workforce may shy away from serving in rural clinics because the pay may be lower than in urban areas.
Medical school administrators told the Senate Committee on Health, Education, Labor and Pensions, that nursing staff are also facing challenges similar to physician staff—the average age of nurses in the U.S. is 54 years and 20% of nurses are 65 or older. Upgrades to our educational infrastructure are essential to support more nursing students and increase scholarship funds. Additionally, highly educated nursing faculty require support and pay equivalent to their clinical counterparts, so they can train and nurture our future workforce.
Policy approaches like these will hopefully have a bigger impact on our medical workforce and patient access worries.
Surabhi Dangi-Garimella, Ph.D. is a biologist who provides education, communication, and strategic support to non-profit groups via her consultancy, SDG AdvoHealth, LLC.