Physician Assistant In Health Care: Working With Underserved Populations

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The current healthcare system continues to face many challenges that affect the delivery of care such as the growing provider shortage in primary care and rising health care costs (9.10). To answer the deficit, health care providers are working towards advancements in both legislation and practice to provide improved access, better nature of care, and lowering overall costs. Optimal Team Practice (OTP) is considered a significant movement to address these concerns and provide a more seamless and efficient system regarding PAs. The overarching ideology is that PAs can provide optimal health care when compared to other medical providers. The research has shown that the health care outcomes and effectiveness of Physician Assistants are comparable to those of both physicians and nurse practitioners in support of this. In addition to health care outcomes, cost effectiveness was an area reviewed which showed favorable results for PAs. The review of data has also suggested the wide range of roles that PAs and NPs can play but the limitations should also be addressed. Some limitations that should be considered, for example, are the fact that PAs and NPs must consider the population they serve (5)

One of the first areas investigated involved cost effectiveness. Specifically, the studies showed that patients treated by PAs had an overall total cost reduction than that of a physician in similar circumstances. Regarding specific conditions such as shoulder tendinitis, otitis media, and UTIs; PAs showed comparable health outcomes with a lower total cost load to both patients and hospital systems. One reason for this involves the fact that the cost of seeing a PA is less than seeing a physician, as noted in the study conducted by Roderick S. Hooker. This fact is also supported by a meta-analysis study which showed that PAs, in general, ordered fewer laboratory tests than physicians with the same complexity patients. According to this study, PAs were able to manage patients in the same way the physician would, with decreased total cost (considering laboratory testing and medications) and similar return rate of the patient in primary care settings. This reduction in cost would help open the doors to underserved populations who may find it difficult to pay for care and be an adequate measure to combat the rising medical costs of today.

In addition to cost effectiveness, this literature reviewed the geographical distribution of PAs, insurance types commonly served, and other social factors where benefits are observed. The literature reviewed suggests that PA/NPs are contributing to our health care system by serving underserved populations and treating patients with both acute and chronic illness as their primary care provider (2). With approximately fifty percent of PAs working in primary care and more likely to work in rural areas; there are more PA visits in underserved populations than other populations (2). Other parameters studied also stated that PA visits included more women and had patients that were generally younger than twenty-five. A high proportion of these patients were also shown to be of lower socioeconomic status and utilize public programs such as Medicaid. This helps prove the propensity of PAs to deliver care to underserved populations in need. In the same vein as how the PA profession began as a stopgap, PAs of today are filling in for the primary care physician shortages especially in the underserved.

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With regards to PA patient outcomes, PAs/NPs have shown growing autonomy and scope of practice. They are treating patients in a comparable fashion to physicians with similar overall outcomes. The results garnered from the Health Utility Index and Short Form Health Surveys showed consistent higher satisfaction scores when PAs were reported as the primary care source. This suggests that PA/NPs are, as medical care suppliers to underserved patients with a variety of sickness severity, are capable, and effective providers. This is also observed in inpatient units, where analytical data showed no statistically significant difference in length of stay, quality of care, or safety when comparing PA groups and MD only groups. The results help drive the point that PAs can deliver safe, effective care to patients in a comparable fashion to medical providers.

With regard to Emergency Medicine PAs, the literature showed that they were able to manage more complex patients and perform more procedures in rural EDs than those by urban PAs. The complexity and procedures performed were increasingly comparable to MDs in similar settings. This difference in patient’s management and procedures performed indicates two different scopes of practice between rural and metropolitan PAs. Although there are no obvious differences in education and training, rural PAs appear to have more autonomy. Furthermore, rural PAs rarely desire or believe that adding more supervising physicians will change the outcome, and in any way necessary, which indicates that they are leaning more towards autonomy.

The current pattern of expanding PA utilization might be an outcome of the critical physician shortage across the country and maldistribution of specialists. Lower volumes of patients in underserved and rural areas make OTP financially burdensome and expanding PA staffing may improve division cost‐efficiency. This issue has likely impacted the extended scope of practice for PAs with less physician supervision that can be seen today. Increased to a broader scope of practice for PAs in rural practice may help make these areas more attractive to PAs interested in a career in a primary care setting. The challenge for PA trainers, preceptors, rural physicians, and rural communities is to sustain and nurture that initial interest in rural medicine

The expansion of PAs or NPs to the ED group demonstrated additionally to improve patient wait time in medium-sized network emergency clinic EDs. So, Given the continuous deficiency of doctors, utilization of social health care insurance addition of PAs and NPs showed to be both cost and outcome effective. These outcomes require more research, as their generalizability to different areas or kinds of EDs isn’t known. Research demonstrated that Populations served by PA/NPs and specialists vary demographically however not in complexity of the disease. Although lower access to care for patients of PA/NPs, there were scarcely any challenges/delays in care or results. This proposes that PA/NPs are going about as main providers to underserved patients with a wide scope of disease severity and complexity, these findings will have significant indications for policy making, including clinician workforce and reimbursement issues. 

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