As the coronavirus pandemic continues to expose shortcomings in our health care system, an outdated law in many states limits the ability of specific health care workers, physician assistants (PAs), to deploy and provide emergency care. In Washington State, a PA must have a delegation agreement filed with the Department of Health, which identifies a supervisory physician for that PA. The scope of practice of each PA is defined by their supervisory physician. For example, if a PA is working under the supervision of a cardiology physician, the scope of practice for that PA is cardiology and related procedures. That PA cannot venture into another specialty, even if they have significant experience or training.
The PA profession was born in post-Vietnam War America when single physician practices wanted to extend their ability to provide care to remote areas with limited health care. These “health care extenders,” many former military medics, attended a shorter version of medical school and were trained under these supervisory physicians to provide care. At the time, this system worked well. More recently, however, this model has proven difficult. As a pandemic sweeps the nation, this model is now woefully inadequate. I personally know PAs working in specialty medicine, but with prior training and work experience in emergency medicine or intensive care that cannot provide care in areas needed most due to the needless restrictions in place.
On March 26th, Governor Jay Inslee signed a one-month emergency proclamation allowing PAs to work independently from their delegation agreements to support medical surge staffing planning for COVID-19. However, this proclamation expired on April 26th. Without legislative changes, highly trained medical professionals will be unable to provide care in areas needed most as the coronavirus pandemic continues through the fall and the coming year. In some cases, these medical professionals are furloughed and collecting unemployment. It is unconscionable to keep these highly trained health care providers at home during a pandemic that is shaking the United States health care system to its core.
Other states have removed the supervisory language in their legislation surrounding COVID response, including Maine, Michigan, New York, and Louisiana, while others, like Michigan, have done away entirely with supervisory language. Instead, they require collaborative relationships to define the PA and physician practice.
Ultimately, no medical provider is fully independent. The practice of medicine occurs in the context of other health care providers and in constant collaboration so that the best and safest decisions are made for and with patients. PAs merely desire the same opportunity to collaborate and to optimize their ability to practice medicine. If Washington’s policymakers fail to modernize PA practice laws soon, a vital and important member of the medical team will not be utilized, and patients will suffer.
Leah Hampson Yoke is a physician assistant.
Image credit: Shutterstock.com
