The role of physician associates in the U.S. healthcare system is both pivotal and growing. Since 2018, the number of certified PAs has increased by 28%, with about 12,000 new positions anticipated annually over the next ten years. These professionals have quickly become central to both specialty and primary care, proving themselves as indispensable assets

In this article, we explore the dynamic roles of physician assistants, including the latest updates on regulations and the complexities of credentialing and privileging. Let's delve into how these changes are shaping the future of healthcare delivery and what it means for the profession.

The Growing Importance of PAs in Healthcare

Physician assistants (PAs) are vital healthcare professionals who work under the supervision of doctors. Their roles are diverse and vary significantly depending on their specialty. In emergency rooms, they assess and treat patients, conduct detailed patient histories and physical exams, and take on critical tasks like admitting patients and assisting in surgeries. Their day-to-day activities also include making rounds, monitoring patient progress, prescribing treatments, and preparing discharge summaries. When collaborating with specialists and subspecialists, PAs often gain unique privileges specific to their fields. Many hospitals also rely on them as key members of the medical and surgical teams, particularly in emergency and intensive care settings.

Physician assistants (PAs) have a wealth of career paths available to them, from managing teams to diving deep into specialized medical fields. They also frequently engage in research and hold academic or teaching positions. Thanks to their versatile training, PAs can switch specialties with relative ease, allowing for a dynamic and varied career. In fact, a 2022 survey found that 40% of PAs are in leadership roles, showcasing their significant presence in guiding healthcare practices.

Despite this variety, most PAs start their careers on common ground, focusing initially on honing their clinical skills. This foundational period is crucial, as mastering hands-on patient care is essential for advancement. Many choose to deepen their expertise by pursuing fellowships or further specializing in areas that interest them.

As PAs gain experience—typically between two to five years—they often begin to take on greater responsibilities. This can mean expanding their scope of practice to include more complex procedures and a larger patient load. To underscore their advanced knowledge, many PAs seek additional certifications like the Certificate of Added Qualifications (CAQ), which highlights proficiency in a particular specialty.

Others may find their calling in leadership, stepping up as team leads or playing key roles in training new staff. These positions allow experienced PAs to shape the future of healthcare within their organizations, ensuring high standards of care and fostering the next generation of medical professionals.

Emerging Trends in PA Roles and Responsibilities

The role of supervising physicians in overseeing Physician Assistants (PAs) has sparked debate within the medical community. Critics argue that placing the burden of responsibility for a PA on a single physician can lead to unnecessary stress for the doctor, suggest that PAs are not capable of independent patient care, and result in slow, cumbersome approval processes. Despite these concerns, the mentorship and support of supervising physicians remain critical to the professional growth of PAs.

In response to these challenges, approximately a dozen states are actively reconsidering the rules governing PA practices. They're aiming to either modify or completely eliminate the requirements for direct physician oversight. This legislative wave includes significant changes like those recently passed in Colorado and Montana, as well as proposals under consideration in states like Illinois, Indiana, Maryland, New York, and Tennessee:

• Arkansas SB 112 empowers Physician Associates to be acknowledged as primary providers for insurance purposes, allowing them to bill directly for their services.
• Arizona HB 2043 removes the necessity for PAs who have accrued at least 8,000 hours of clinical experience to maintain a formal agreement with a supervising physician.
• Montana HB 313 changes the PA-physician relationship from supervisory to collaborative, removing the need for written agreements for experienced PAs.
• South Dakota SB 175, which did not pass, would have allowed PAs to diagnose, treat, and prescribe independently.
• Colorado SB 083 updates laws to enable most PAs to work in collaboration with physicians rather than under their direct supervision, significantly broadening their operational flexibility.
• Iowa Senate Studies Bill 1142 aims to abolish the requirement for PAs to work under the direct supervision of licensed physicians.
• Maryland SB 167 and New York’s AB 7725 & SB 5520 are shifting towards models where PAs can operate with more autonomy within specific frameworks.

Moreover, the introduction of the PA Licensure Compact exemplifies a growing trend. This compact, once fully operational, will facilitate interstate practice for PAs, enhancing their mobility and the accessibility of medical services across state lines. These changes, while not suggesting that PAs will replace physicians, are poised to expand the scope of PA practice, ensuring they can meet the evolving needs of the healthcare system more effectively.

Expanding Horizons: The Shift to Physician Associate

The American Academy of Physician Associates (AAPA) has officially changed its name, marking a significant shift in the identity of this crucial healthcare role. This name change is more than just a formality; it's a strategic move towards redefining the profession's image to better reflect the advanced level of care and expertise provided by these medical professionals.

Changing a professional title involves coordinating with a myriad of independent organizations, as well as navigating the complex terrain of state and federal regulations. The transition to the new title, "Physician Associate," is expected to take several years due to the breadth of changes required across various platforms and materials, including branding assets and digital tools.

The AAPA is leading the charge to ensure a smooth transition by working closely with entities that oversee PA education and certification. This includes the National Commission on Certification of Physician Assistants (NCCPA), the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA), and the Physician Assistant Education Association (PAEA). These organizations, along with state chapters, are pivotal in implementing the new title across the profession.

Several specialized groups within the profession have already embraced the new title, including:

• Geriatric Medicine PAs
• Academy of Physician Associates in Cardiology
• Physician Associates for Latino Health
• African Heritage Physician Associate Caucus
• Physician Associates for Oral Health
• Association of Physician Associates in Obstetrics and Gynecology
• National Association of Physician Associates in Cannabis

Each state's PA chapter is tasked with the local implementation of the name change, ensuring compliance with legal and regulatory requirements. The AAPA is providing support to facilitate these updates effectively.

Despite widespread support within the profession, the transition has faced criticism. Some, including the American Medical Association, worry that the new title might confuse patients and suggest a move towards more autonomous practice. However, this change aims to more accurately represent the role's scope and the level of care provided by PAs, rather than suggesting a shift away from the collaborative, physician-led model of care.

To address concerns and educate the public about the evolving role of PAs, the AAPA launched the "PAs Go Beyond" campaign in May 2022. This initiative highlights the critical role PAs play in the increasingly strained healthcare system and aims to clarify any misconceptions about the profession.

PAs are advised to use the title "Physician Associate" only if it is officially recognized by the state governing their license. Using the incorrect title can lead to significant legal issues, affect malpractice insurance, and cause regulatory complications.

Ultimately, whether called a PA, Physician Assistant, or Physician Associate, these professionals are integral to the healthcare system, providing essential services that extend far beyond basic medical care. The new title is just one step towards acknowledging their vital contributions.

The Impact of Licensing Compacts on PA Practice

The Physician Assistant (PA) licensure compact officially came into effect on April 4, 2024, when Virginia Governor Glenn Youngkin signed the bill, marking Virginia as the pivotal seventh state to activate this transformative agreement. This compact is designed to simplify the licensing process across participating states, thereby enhancing PA mobility and aligning with the professional goals of adaptability and lifelong learning.

The legislative journey saw Minnesota and Tennessee recently becoming the 11th and 12th states to adopt the PA Licensure Compact model legislation, signaling strong continued momentum in the reform of PA practice across the United States. The local PA community in Minnesota expressed significant appreciation for the recognition by their legislature, which acknowledges the substantial role PAs play in delivering quality healthcare.

Governor Bill Lee of Tennessee also contributed to this legislative advancement by signing SB 1727 and SB 2136, further enhancing practice flexibility for experienced PAs within Tennessee. This opens new possibilities for PAs, particularly in telemedicine and cross-border healthcare due to Tennessee's geographical placement adjacent to eight other states. This legislative change is poised to streamline healthcare delivery, reduce burdens, and improve patient access to medical services across a broader region.

States that have enacted the PA Compact model legislation include:

• Delaware
• Utah
• Washington
• Wisconsin
• West Virginia
• Nebraska
• Virginia
• Oklahoma
• Maine
• Colorado
• Minnesota
• Tennessee

The activation and operationalization of the compact, which is expected to take between 18 to 24 months, will allow eligible PAs to apply for a compact privilege, functioning much like a multistate license, to practice in any of the compact states.

A recent survey highlights the strong support within the PA community for the compact, though it also reflects some concerns about the pace of implementation.

• A resounding 99.7% of PAs support the implementation of the compact, with only a single respondent opposing.
• 91% of PAs believe the implementation process is taking too long, suggesting a desire for more rapid adoption across states.
• A significant majority of PAs (95%) say they would consider working in a different state if the PA Licensure Compact were in place, indicating the compact's potential to enhance career flexibility and healthcare accessibility.
• An overwhelming 99% of PAs agree that the compact will increase patient access to high-quality healthcare.
• 99.5% of respondents advocate for every state to implement the PA Licensure Compact, underlining the widespread belief in its benefits both for healthcare professionals and the communities they serve.

The PA licensure compact stands as a critical development in healthcare regulation, promising to significantly expand access and adaptability for PAs, enabling them to meet urgent health needs across state lines more effectively. With strong legislative backing and substantial support from the PA community, the compact is set to reshape the landscape of healthcare practice in the United States.

Analyzing PA Compensation: Trends and Influences

Career growth and salary increases go hand in hand for Physician Assistants (PAs). Although salaries can vary by specialty and employer, the average PA earns a respectable $134,000 annually, as reported in the Medscape Physician Assistant Compensation Report 2023. High-demand specialties like dermatology, emergency medicine, and surgery tend to offer even higher wages.

Despite these figures, many PAs feel their compensation doesn't quite hit the mark. The Medscape report highlighted a 4% rise in average PA compensation from 2021 to 2022, yet half of the surveyed PAs expressed dissatisfaction with their pay—a significant jump from 26% in 2020. Various factors contribute to this dissatisfaction: rising inflation making stable salaries feel smaller, primary care roles typically offering lower pay and longer hours, and the slow pace of salary increases compared to those of physicians.

Interestingly, 60% of PAs noticed an income increase over the previous year, while a third reported stable earnings. This modest 4% increase reflects a combination of higher base salaries and bonuses, climbing from $129,000 in 2022.

Experience plays a crucial role in compensation, with PAs over 45 typically earning 13% more than their younger colleagues. But fair pay isn’t just about the numbers—it’s influenced by work location, area of expertise, cost of living, and even the mundane tasks like fielding calls and handling paperwork.

The latest survey showed a drop in satisfaction with compensation since 2020, with only half of PAs feeling they are fairly compensated today. This sentiment is consistent across all ages and genders, suggesting that factors like age or gender have little impact on perceptions of pay equity.

Experts argue that fair compensation should account for time spent on non-revenue generating activities, such as administrative tasks. PAs who believe their full range of duties is adequately compensated are more likely to view their pay as fair.

PAs predominantly work in medical offices and clinics, making up 46% of the workforce, while a smaller percentage works in more acute settings like emergency rooms and operating theaters. The hourly wage model appears to offer more satisfaction, with hourly PAs earning an average of $135,000 compared to $128,000 for salaried PAs, possibly due to a clearer alignment between hours worked and compensation received.

PAs operate in various practice settings, and their earnings fluctuate slightly across these settings. The most significant number of surveyed PAs work in medical offices or clinics (46%), followed by emergency departments/urgent care (15%), acute care hospitals/inpatient units (14%), and operating rooms/surgery (10%).

Those serving in operating rooms and surgical settings reported an average annual salary of $145,000. In contrast, PAs in medical offices and clinics reported an average of $129,000, a rise from $124,000 in 2021.

Across the U.S., PA salaries vary widely. The Pacific region, including states like California and Washington, is known for higher wages, though this can be offset by the high cost of living. Conversely, regions with lower pay might offer a better quality of life, attracting PAs interested in locum tenens roles that provide flexibility and meet personal lifestyle preferences.

While PA salaries are generally competitive, there's a complex mix of factors that influence how PAs feel about their compensation. Addressing these concerns will be key to maintaining satisfaction and retaining skilled professionals within the healthcare system.

Physician Assistants Credentialing and Privileging

For Physician Assistants (PAs) to deliver patient care in hospitals, they and their supervising physicians must secure specific clinical privileges. These privileges, defined in the hospital's medical staff bylaws, outline what PAs are authorized to do in a clinical setting. These bylaws typically include a definition of a PA that aligns with state laws and the broader definition provided by the American Academy of Physician Assistants. For instance, a PA is described as someone who has graduated from a program accredited by the Accreditation Review Commission on Education for the Physician Assistant (or its predecessors) and is certified by the National Commission on Certification of Physician Assistants, holding a valid license to practice under physician supervision.

These bylaws must ensure that the scope of granted privileges is in line with all relevant state laws and that a PA's medical services fall within the practice scope of their supervising physician. For hospitals looking to update their bylaws with this information, resources are readily available on professional sites like the AAPA’s policy page.

Before a hospital grants these privileges to a PA, it must confirm that the PA is properly licensed, certified, or registered, and carries sufficient liability insurance. This verification process includes checks with the National Practitioner Data Bank (NPDB) for any malpractice history and the Federation of State Medical Boards (FSMB) for any disciplinary actions.

Additionally, the American Medical Association’s (AMA) Physician Assistant Profile Service provides a method for verifying a PA's educational background, certification status, licensure history, and association memberships. This service, available for a fee, is recognized by accrediting organizations like the Joint Commission as providing data equivalent to primary source verification.

In practice, many hospitals tailor their credentialing processes for physicians to accommodate PAs. This involves setting specific criteria that PAs must meet, which are typically laid out in the medical staff bylaws or an associated policy and procedures manual. Once a PA demonstrates the requisite training and experience and gains approval from either the hospital board or a designated authority, they are granted the necessary clinical privileges under the supervision of a physician who holds corresponding privileges. This integrated approach ensures that PAs are equipped and authorized to provide high-quality care within the healthcare setting.

Using Software to Streamline PA Credentialing

Utilizing a credentialing service or system like Credsy can significantly streamline the process for physician assistants, making it more efficient and error-free. Here’s how such systems enhance the credentialing experience:

• Streamlining Credentialing: These systems automate many steps of the credentialing process. This automation is particularly beneficial when managing multiple credentials and navigating the varied licensing requirements across different states, helping to save valuable time and minimize human error.

• Centralizing Credential Storage: For locum tenens professionals who often move between states and healthcare facilities, having a single repository where all credentials are stored simplifies management. This centralized system ensures that credentials are easily accessible and can be quickly shared with potential employers or regulatory bodies as needed.

• Ensuring Compliance: Keeping up with the diverse and changing credentialing requirements across different states and organizations can be daunting. Credential management systems stay updated with the latest regulations, ensuring that all credentialing activities are compliant with current laws and organizational standards.

• Increasing Efficiency: By centralizing the management of credentials, systems like Credsy reduce the administrative load on healthcare professionals. This allows them to devote more time to patient care and other core duties, rather than getting bogged down by paperwork and manual verification processes.

Overall, adopting a sophisticated credential management system can transform the credentialing process from a cumbersome administrative task into a streamlined, efficient operation. This not only benefits the healthcare professionals by reducing their administrative burden but also enhances the overall functionality of healthcare organizations by ensuring quick and compliant credential verification.