Anyone who has tried recently to get an appointment with a family physician likely has encountered a fact of life in today’s health care system: Patient loads are increasing faster than medical schools are turning out doctors, and access to care in outpatient settings is getting tougher.
A new training program at the LSU Health System in New Orleans that soon will graduate its first students aims to help address that crunch in the area by putting dozens of physician assistants into the marketplace.
The first 30 students in the program are slated to graduate in May. Program Director Debra Munsell said a second group of students began classes early this year, and a third class will start in January.
“As soon as we were accredited to start the program, physicians began calling, wanting a physician assistant,” she said, noting that the demand is coming from doctor groups and specialty practices, as well as hospitals.
The 29-month program is part of a multifaceted effort by health care providers to address a physician shortage that many say lies ahead. It arises from the fact that as the existing population of doctors ages and retires, medical schools are turning out too few graduates to replace them.
Meanwhile, the Affordable Care Act is bringing millions more people under the umbrella of health insurance coverage, and many are expected to seek health care in the private sector for the first time.
The Association of American Medical Colleges estimates that by 2020, the total number of primary care doctors in the United States will fall about 45,000 doctors short of meeting demand.
One potential key to alleviating the shortage is the deployment of intermediate-level medical professionals, such as physician assistants.
A physician assistant, or PA, is a nationally certified, state-licensed medical professional who practices on a health care team with physicians and other providers. A PA can conduct physical exams, diagnose and treat illnesses, write prescriptions, order tests and even assist in surgery.
PAs are trained as generalists and must renew their certification every 10 years. But they can also train to work in many specialty areas, from emergency care to cardiothoracic surgery, said John McGinnity, president of the American Academy of Physician Assistants.
McGinnity, a PA in Detroit, said that within his own 20-year career he has worked in emergency rooms, occupational medicine, cardiology and internal medicine.
“PAs have great flexibility, and that allows us to address the maldistribution (of care) issue unlike any other health care provider out there,” he said.
The use of physician assistants has been slower to develop in Louisiana than in more densely populated areas, such as the Northeast, where patient loads have grown faster. But PAs are becoming increasingly visible in local clinics and hospitals.
At Ochsner Health System in New Orleans, about 90 PAs serve patients in a variety of areas ranging from outpatient clinics to intensive care units. Ochsner urologist Lester Prats predicts their ranks will grow.
“We’re seeing more patients, with not many more medical professionals,” he said. “I would anticipate that we’re going to continue hiring because demand is going up.”
As medical director of advance practice providers at Ochsner, Prats oversees the deployment not only of PAs, but also nurse practitioners, midwives, nurse anesthetists and clinical nurse specialists. Some 400 such professionals now practice in the hospital and clinics, he said.
“They’re well-trained and very good at what they do, and they really help us a lot,” he said.
While Ochsner has employed PAs and nurse practitioners for nearly two decades, Prats said hiring has sped up, with 60 new hires coming on board in the past year.
Prats said he’s “thrilled” that a new PA training program has launched in New Orleans, joining the state’s two other programs, in Baton Rouge and Shreveport.
Program Director Munsell expects that newly graduated PAs will be snapped up quickly as the new University Medical Center and Veterans Affairs Medical Center, now under construction in Mid-City, open in 2015 and 2016, respectively.
To enter into PA training, an applicant must have a bachelor’s degree from an accredited U.S. university and must have completed a specific set of science courses, similar to a premed curriculum.
Munsell said the competition for the program is stiff. “We had more than 300 qualified applicants for 30 spots,” she said.
John Allgood, who runs the PA training program that began in 2006 at Our Lady of the Lake College in Baton Rouge, said “economics” have a lot to do with the growing use of PAs.
“You can put two PAs with a physician in a hospital and see as many patients as three doctors would, but PAs cost about half as much as a physician to employ,” he said.
In an outpatient setting, Allgood said, a PA can do at least 80 percent of what a primary care physician would do, from physical exams to suturing lacerations to setting fractures.
Along with costing less than a physician to employ, PAs cost a lot less to train, he added.
“It costs about $630,000 to train a physician and about $130,000 to train a PA,” he said.
Health care managers in nearly every setting are likely to be evaluating these and other factors as pressures on the system grow. The ability of PAs and nurse practitioners to move across specialties could come into increasing focus as the nation’s health care system runs short not only of primary care doctors, but specialists as well.
“As of next year, we’ll be down about 30,000 primary care people in this country, but we’ll also be short over 30,000 specialists too,” said Prats, at Ochsner.
Pointing out that many PAs and nurses who now have master’s degrees are choosing to pursue doctorates, he said their ability to take on high levels of responsibility for patient care is increasing right along with the demand.
“We really need these people,” he said. “They are a very important part of the business we’re in.”