If two years of the COVID pandemic have taught us anything, it is that the U.S. healthcare system is anything but perfect. At the pandemic’s height, many states went so far as to temporarily relax rules regarding how and where physician assistants and nurse practitioners can work. Now, with the pandemic mostly behind us, it is time to answer an important question: are physician assistant jobs jeopardized by supervision rules?
The question was central to the debate of a bill that was recently defeated in Colorado. House Bill 1095 would have given physician assistants a bit more freedom to practice independent of direct physician supervision. In the end, the bill was defeated after heavy lobbying by medical groups and others opposed to the changes.
Access to Quality Care
Among its provisions, House Bill 1095 would have allowed physician assistants to work independently, but still require them to consult with a patient’s healthcare team, as they already do. Those opposed to the measure argued that freeing PAs from direct physician supervision would limit access to quality care. Some argued it could even be dangerous. The argument appears sound, but there are two sides to every coin.
Proponents of the bill argued that PAs routinely live under the shadow of potential unemployment because their work is intrinsically tied to a physician’s job. In rural areas for example, there may be a single physician assistant working under the supervision of a single doctor. If that doctor decides to leave and go elsewhere, not having another doctor to immediately step in could mean the physician assistant loses their job. Likewise, patients served by that PA would lose access to healthcare services.
Is either situation better or worse than the other? That is for politicians to figure out. In Colorado, they decided it is better to maintain the status quo. For the time being, PA jobs in the state will continue being subjected to physician supervision.
Other States Are Loosening Up
If you are in favor of less supervision for physician assistants, you will be happy to know that other states are loosening their restrictions. A bill passed in Utah in 2021 eliminates the direct supervision requirement after a PA works for so many hours under a doctor.
For example, a PA would work directly under a supervising doctor for 4,000 hours. After that, another 6,000 hours of supervision would be required – either under a doctor or another PA with 10,000 hours of experience. Completing both regimens would give a PA 10,000 hours of supervised work, leading to the right to practice independently.
Scope of Practice Remains the Same
Whether you are talking Colorado’s defeated bill, Utah’s passed bill, or rules in any of the other states, the bigger issue is scope and practice. A PA’s scope and practice is clearly defined by state law. Proponents of the unsupervised work model say that PAs are not looking to broaden it. They are happy to continue doing what they do. They simply want to be able to do it without being tethered to a physician whose interests may or may not be aligned with the PA’s.
What we are really talking here is primary care. That is what PAs provide in most settings. They handle routine cases so that doctors can focus on more serious cases. As a patient, this makes sense to me. If a physician assistant is trained and licensed to provide primary care, direct supervision by a doctor seems redundant.
Are physician assistant jobs jeopardized by supervision rules? Proponents of Colorado’s recently defeated bill seem to think so. They make a good point.