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Research & Commentary: Expanding the Role of Physician Assistants in Rhode Island

May 10, 2019

In this Research & Commentary, Matthew Glans examines a bill in Rhode Island that would allow physician assistants to care for patients without being directly supervised by medical doctors, dramatically improving their ability to provide care.

Like many states, Rhode Island is experiencing a health care shortage, leaving many patients seeking basic primary care services. To maintain current rates of primary care utilization, Rhode Island will need “an additional 99 primary care physicians (PCP) by 2030, a 11% increase compared to the state’s current (as of 2010) 830 PCP workforce,” according to the Robert Graham Center. In 2032, the Association of American Medical Colleges estimates the United States will have a doctor shortage of 122,000 physicians.

Making matters worse, by 2032, the number of people over age 65 will increase by 48 percent, according to the U.S. Census Bureau, which will likely exacerbate the growing primary care shortage.

In 2018, Rhode Island increased the number of PCPs practicing in the state to just 905. Given the increased demand for primary care services, Rhode Island’s health care market is not generating the number of primary care providers the state will need in the long term.

Limiting or preventing a physician shortage is made more complicated by the fact that becoming a licensed health care provider is an expensive and slow process. Strict licensing standards have become a significant barrier to entry in many fields, but nowhere is the effect of licensing more sharply felt than in the health care industry. In many instances, states control licensing standards, professional discipline, and the various costs associated with the process. These standards are usually championed by existing practitioners to slow or block entry of new competitors.

Supporters of strict state licensing standards argue they assure quality. However, critics argue the arduous and expensive licensing process negatively impacts the health care market by hindering entry for new physicians and thereby impedes the competition that lowers costs and improves consumer access to health care services.

One reform that could help provide better care for Ocean State patients is the expansion of the scope of responsibilities permitted for physician assistants (PA). In Rhode Island, physician assistants are required to operate under the supervision of a licensed doctor. This limits the effectiveness of physician assistants and creates problems if a doctor’s circumstances change. For instance, if a doctor relocates, retires, or dies, a PA can no longer provide these services without finding another doctor willing to supervise him or her.

Fortunately, a bill proposed in Rhode Island, H. 5572, would allow physician assistants to care for patients without being directly supervised by medical doctors, as long as the two are working “in collaboration.” The bill would also allow for PAs to be listed as primary care providers and would relieve doctors of liability for the work of their PAs. The Rhode Island House approved H. 5572 in May.

Physician assistants are well-educated, well-trained professionals. In Rhode Island, PAs are required to receive at least a master’s degree and complete more than 2,000 hours of clinical rotation. According to a study by United Health, “the quality of primary care delivered by PAs in health centers, along with their referral patterns and their patients’ service use, is largely comparable to that delivered by physicians and NPs.”

Eliminating the obstructive and unnecessary supervision requirements for PAs would be a good step toward increasing the number of caretakers practicing in Rhode Island, which would reduce the primary care physician shortage and increase the availability of health care to patients across the Ocean State.

The following articles examine America’s primary care doctor shortage, scope of practice, and medical licensing from varied perspectives.
 

NPs, PAs Could Reduce Primary Care Physician Shortage Nearly 70%
https://patientengagementhit.com/news/nps-pas-could-reduce-primary-care-physician-shortage-nearly-70
Sara Heath writes in Health Engagement Hit that physician assistants and nurse practitioners have the potential to fill primary care gaps.

Addressing the Nation’s Primary Care Shortage: Advanced Practice Clinicians and Innovative Care Delivery Models
https://www.unitedhealthgroup.com/content/dam/UHG/PDF/2018/UHG-Primary-Care-Report-2018.pdf
Non-physician health care practitioners can help reduce the nation’s shortage of primary care providers, according to this report from United Health Group.

Improving Efficiency in the Health Care System: Removing Anticompetitive Barriers for Advanced Practice Registered Nurses and Physician Assistants
https://www.heartland.org/publications-resources/publications/improving-efficiency-in-the-health-care-system-removing-anticompetitive-barriers-for-advanced-practice-registered-nurses-and-physician-assistants
In this paper for The Hamilton Project, E. Kathleen Adams and Sara Markowitz propose two major reforms that would dramatically increase the availability of primary care services: the expansion of the scope of practice for advanced practice registered nurses and a reform that would require the supervisory relationship between physician assistants and physicians to be determined by each practice, not the government.

Primary Care Physician Shortages Could Be Eliminated Through Use of Teams, Non-Physicians, and Electronic Communication
https://www.heartland.org/publications-resources/publications/primary-care-physician-shortages-could-be-eliminated-through-use-of-teams-nonphysicians-and-electronic-communication
In this article from Health Affairs, Linda V. Green, Sergei Savin, and Yina Lu discuss how innovations such as improvements in information technology and data sharing, as well as the use of nonphysicians, could help to alleviate much of the primary care physician shortage.
 

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News, The Heartland Institute’s website, and PolicyBot, Heartland’s free online research database.

The Heartland Institute can send an expert to your state to testify or brief your caucus, host an event in your state, or send you further information on a topic. Please don’t hesitate to contact us if we can be of assistance! If you have any questions or comments, contact George Jamerson, Heartland’s director of government relations, at gjamerson@heartland.org or 312/377-4000.

Author
Matthew Glans joined the staff of The Heartland Institute in November 2007 as legislative specialist for insurance and finance. In 2012, Glans was named senior policy analyst.
mglans@heartland.org @HeartlandGR