Physician Assistants as Primary Care Providers

Physician assistants or PAs are medical professionals that make up a critical part of the healthcare workforce, especially in primary care. While physician assistants aren’t medical doctors, they may perform many of the services traditionally provided by MDs, including physical exams, ordering and interpreting tests, and advising patients on preventative health care (1). The role of physician assistants in primary care is becoming increasingly important due to a shortage of medical doctors specializing in primary care (3). As the population in the United States ages and more people gain access to insurance coverage, physician assistants are expected to make up more of the share of providers that provide routine primary care to patients (1). 

The role of the physician assistant was first conceptualized in the 1960s to address the shortage of medical professionals in primary care (2). Since then, the number of PAs in the medical field has increased, but the percentage of PAs working in primary care has gone down (2). Research indicates that physician assistants who choose to work in primary care share many of the demographic characteristics of medical students who become primary care doctors. PA and MD students that identify as women, are older, and come from lower-income socioeconomic backgrounds are more likely to work in the primary care field, perhaps because they better understand the healthcare needs of medically underserved communities and minority groups (2). 

Furthermore, studies have found that physician assistants are more likely to work in non-teaching hospitals and provide care to Medicaid recipients, uninsured patients, and younger patients (1). PAs are also more likely to work in smaller medical facilities in remote areas that would otherwise be classified as medically underserved communities without their presence (1). 

Physician assistants and nurse practitioners may deliver care that is more preventative compared to traditional doctors, who tend to address pre-existing health issues or complex cases (1). Long-term trends indicate that physician assistants and nurse practitioners may become the main primary care providers in the future, allowing MDs to perform more managerial roles and focus on in-patient care in hospitals.

Working with a physician assistant can provide multifarious benefits for medical doctors and clinics. For example, PAs can allow medical clinics to handle larger patient caseloads and give doctors the ability to lower their workload (3). The presence of a PA may decrease waiting times and increase the quality of care since medical facilities will be less overburdened. As a result, doctors can focus their energy on more complex cases and patients can experience more attentiveness and preventative care during their visits. 

While doctors report a high level of support for the PA profession, some MDs consider physician assistants to be time-consuming and expensive for healthcare facilities due to increased administrative tasks and a higher volume of low-revenue patients (3). Recently, the national organization for physician assistants rebranded its organization to be called the American Academy of Physician Associates (5). This internal change in the name of the profession reflects a desire for PAs to be viewed as mid-level healthcare providers rather than “assistants” that simply provide help to physicians. The name “physician assistant” can cause confusion amongst patients, since, in many cases, PAs no longer work under the direct supervision of a physician in the same clinic. However, doctors are still required to meet regularly with PAs and review sample patient charts in some states (5). 

Physician assistants continue to advocate for more autonomy in their scope of practice to fill in existing gaps in primary care and move towards more prevention-focused healthcare methodologies while maintaining a team-based approach to healthcare collaborating with doctors. Evidence suggests that prioritizing primary care and encouraging more physician assistants to work within the field helps increase the accessibility of medical care and results in lower medical costs for patient populations (6). 

References 

1. Cawley, James F. “Physician Assistants and Their Role in Primary Care.” Virtual Mentor, 2012, vol. 14, no. 5, pp. 411-414, doi: 10.1001/virtualmentor.2012.14.5.pfor2-1205. 

2. Coplan, Bettie et al. “Physician Assistants in Primary Care: Trends and Characteristics.” Annals of Family Medicine, Jan 2013, vol. 11, no. 1, pp. 75-79, doi: 10.1370/afm.1432  

3. Halter, Mary et al. “The contribution of Physician Assistants in primary care: a systematic review.” BMC Health Services Research, 18 June 2013, vol. 13, no. 223, doi: 10.1186/1472-6963-13-223 

4. Jaspen, Bruce. “Physician Assistant Demand Rivals That of Primary Care Doctors.” Forbes, 19 Feb 2016, www.forbes.com/sites/brucejapsen/2016/02/19/physician-assistant-demand-rivals-the-need-for-primary-care-doctors/ 

5. Rau, Jordan. “Physician assistants want to be called physician associates, but doctors cry foul.” NPR, 3 Dec 2021, www.npr.org/sections/health-shots/2021/12/03/1059916872/physician-assistants-want-to-be-called-physician-associates-but-doctors-cry-foul 

6. van Erp, R.M.A. et al. “Physician Assistants and Nurse Practitioners in Primary Care Plus: A Systematic Review.” International Journal of Integrated Care, 12 Feb 2021, vol. 21, no. 6, doi: 10.5334/ijic.5485.s110.5334/ijic.5485.s1doi.org/10.5334/ijic.5485.s1