By Tracey Drury – Senior Reporter, Buffalo Business First
Feb 27, 2024
With a physician shortage continuing nationwide, hospitals and physician practices are increasingly relying on physician assistants and nurse practitioners to meet ongoing needs. Now an effort is underway in New York to change how PAs are recognized and what duties they can perform.
Gov. Kathy Hochul’s executive budget for 2024-25 includes proposed legislation that would allow qualified PAs to practice without physician supervision, prescribe medications and treatments, and to be hired as directors of school health services. The change restores autonomies that PAs had in place during the pandemic under an executive order that expired last June.
PAs are licensed in New York to see patients of any age in any setting or specialty. According to the New York State Society of Physician Assistants, the proposal doesn’t change the scope of practice for PAs, but instead removes what it calls administrative barriers while expanding access for patients. The proposal would apply only to professionals who have more than 8,000 hours of practice under their belts who are practicing in primary care and certain non-surgical specialties, or in a health system of hospital where they have privileges.
The American Academy of Physician Associates, which is lobbying on behalf of the change, said the change would help increase access, pointing to average wait times in New York of 4.5 weeks for a medical appointment – longer than the 3.9-week national average. They point to a national survey that shows patients are worried about healthcare workforce shortages, with 90% saying having a PA on staff makes it easier for them to make an appointment.
Hospital and private practice executives agree the PAs are an important part of the system, but don’t all agree these professionals should be operating without physician supervision.
Sheila Kee, chief operating officer, at Niagara Falls Memorial Medical Center, said its five primary care practice sites rely more heavily on nurse practitioners, while PAs have served as surgical assistants in the operating room and for follow up care. In other settings, such as orthopedics, it might be more appropriate. But she said it’s still good medical practice to require voluntary or mandatory monitoring and oversight by physicians.
On the other hand, Kee said, recruiting primary care doctors has never been tougher.
“There’s such a shortage of providers – doctors, nurse practitioners, physician assistants – and in light of the critical shortage of surgical providers, it will ease up that issue somewhat,” she said. “Doctors are busy, busy, and it will relieve them of some responsibilities to some degree.”
PAs and NPs are employed by Kaleida now in just about every service line across Kaleida Health, especially as team-based care has evolved over the past 10-15 years, said Dr. Michael Mineo, chief medical officer.
“I also think we should remove unnecessary restrictions that decrease access to care, but, that said, there should be some level of collaboration and partnership to ensure quality,” he said. “They’re all pushing toward complete autonomy. I feel what’s best is a team-based model with some level of collaboration. That level could be debated endlessly, but APPs and PAs are essentially to increasing access to care, particularly in primary care.”
The professional associations at both the state and national level insist the change won’t affect team-based care. That's good, said Dr. John Notaro, medical director at Buffalo Medical Group, who said PAs and NPs are a critical part of the team, representing about 80 of its total 200 medical providers. It’s important to remember, he said, that though the training for both professions is rigorous, it’s far less intense than medical school and residency.
Notaro said there’s no reason why PAs shouldn’t be able to prescribe medical equipment or home nursing orders, but is hesitant to allow full autonomy, especially with the ongoing shift in health care toward full-risk payment models.
The legislation as currently written would not affect all PAs, including those in surgical or specialty practices like Kelly Jordan, the lead PA at UBMD Orthopaedics & Sports Medicine and a clinical adjunct professor and preceptor for D'Youville University, Daemen University and Canisius University.
“If it were to be extended to even our nonsurgical portion of orthopedics, then we could definitely benefit from that, allowing further access to more patients without the need for supervision by physicians,” she said. “The numbers continue to grow year after year. We always have a desperate need for more providers to ensure we’re facilitating patient care in a timely and efficient manner."
New York would follow such states as North Dakota, Utah, Wyoming, Iowa, Arizona and Montana in removing the physician supervision requirement, said Ed Mathes, president of the state society of PAs.
“It’s not independent practice. We’re not eschewing team-based care. We’re just trying to remove barriers to practicing,” he said.