Maximizing Physician Assistants in a Practice

There were more than 83,000 physician assistants in the U.S. last year, about double the number from a decade ago, according to the American Academy of Physician Assistant’s 2010 Census. The increase is significant, to be sure, but AAPA President Robert Wooten, PA-C, says there are important advances beyond the numbers.

“There has been a tremendous increase in the recognition of the work that PAs do, particularly from patients, but also from the medical community at large,” Wooten says. “There is a dialogue taking place with the physician community that hadn’t taken place before. I think it will have a tremendous impact on our ability to deliver health care.”

By the numbers

The projected 90,000-physician shortage by 2020, particularly in primary care, has been well publicized. Combined with an influx of patients coming into the system, the need to fill the primary physician gap is significant. Wooten believes that PAs are an effective and cost-efficient answer to the pending problem.

“The Medical Group Management Association has said that for internal medicine PAs, for every dollar in reimbursement received by a PA-provided service, PAs take out 56 cents in salary costs,” Wooten says. “Physicians take out upwards of 70 cents in salary for every dollar of revenue collected. Economically, we certainly are cost effective.”

Lisa Shock, MHS, PA-C, a CompHealth consultant, agrees. She explains that PAs receive an average annual salary of about $80,000. The typical median income for a practice is $231,000 in collected revenue.

“Do the math,” Shock says. “If you have the patient volume, you can decrease costs and keep patients out of the emergency room.”

And PAs are more versatile than simply lending their support in the primary care arena. According to the AAPA 2010 Census, 26% of PAs work in a single-specialty physician group practice; 12% work in a multi-specialty group practice; and 14% work in a hospital emergency room.

“PAs are like Type O blood,” Shock says. “We practice in every single specialty and every setting.”

Working with a PA

If a medical practice is thinking of bringing in one or more PAs, the physicians first need to know what they want, what the need is for them, and how they want to use the PA in their practice, according to Wooten. How is the PA going to fit in and provide maximum benefit?

Wooten suggests speaking with other practices, regardless of specialty, that have PAs. Or physicians can become a teacher and have PA students work in the practice.

“You want to see how the physician and PA work together,” he says. “PA students are extremely effective in working in a practice. You get a feeling for their knowledge base, and it also helps the PA programs train the students.”

Wooten has been a PA for 30 years. He recalls that on his first job in a family practice he would meet the physician at the hospital at 7 a.m. for rounds. When patients were going to be discharged, he would handle those arrangements while the physician went back to the office to begin seeing patients.

If a call came in regarding a patient in the intensive care unit at the hospital, the physician could attend to that patient, and Wooten would stay in the office and see patients.

“We didn’t have to shut down the office and wait for him to come back,” Wooten explains. “The office stayed open all the time. That was a very effective use of time. It was a real team effort.”

Shock echoes those thoughts. She explains that a common thread running through primary care and other areas of medicine is that physicians need more help, and they need more time. That’s where PAs can make an important difference.

“If a practice is trying to educate patients on flu shots, this is one area where a PA can help during the busiest months of the year,” Shock says. “Physicians can test drive a PA in their practice setting through a temporary contract arrangement. A lot of practices are staying open one or two nights a week for urgent care, or opening on a Saturday morning for flu clinic. That’s the perfect place to staff a PA. It’s an opportunity to understand what PAs do, and what we can bring to the table.”