Defining physician assistant practice autonomy

Redefining the PA-physicians relationship to recognize PA autonomy
Redefining the PA-physicians relationship to recognize PA autonomy

SAN FRANCISCO — The more years in practice a physician assistant has the less amount of time they spend consulting with a collaborating physician, researchers found.

This correlation is strongest among primary care PA, and is less apparent in PA-physician teams in other subspecialties, such as surgery and internal medicine, James F. Cawley, PA-C, MPH, a professor in the George Washington University Physician Assistant Program in Washington, D.C., reported during a session at the American Academy of Physician Assistants 2015 meeting

Discussion about autonomy and increasing autonomy in PA practice has been ongoing for a number of years as the PA-physician relationship has evolved from the idea of the physician role being a that of a supervisor to being that of a collaborator. 

However, many state legislatures still use the term “supervising physician” in the language that defines PA cope of practice rather than the AAPA-endorsed term "collaborating physician. 

“With our study, we were attempting to put some sort of measure on increasing autonomy that we anecdotally see take place in primary care practices as the physician-PA team gains more experience,” Cawley said. 

So he and Noël Smith, senior director of PA Industry Research & Analysis at the AAPA, looked at data from the 2013 National PA survey to determine the frequency of consultation with a physician and how it correlated with PA experience levels. 

Based on years in practice, they found the following proportion of primary care PAs spent less than 10% of their time consulting with a physician:

  • 77% of those in practice 20 years or more
  • 75% of those in practice 15 to 19 years
  • 68% of those in practice  10 to 14 years or more
  • 63% of those in practice 5 to 9 years or more
  • 50% of those in practice 4 years or fewer

“It's of interest that primary care PAs seem to be the ones with the most autonomy compared with other subspecialties, but it's no surprise from a practical standpoint, such as in surgical subspecialties where you expect the PA to be side-by-side with a physician,” said Cawley

“There is a need for more far-ranging and precise studies of PA practice autonomy. The PA profession, in its quest to redefine their practice relationship with physician should select a term and define that term specifically,” he added. 

However, Cawley acknowledged that many PAs are happy with the current system of defining the PA role, believing that existing language gives them maximum flexibility and minimal liability.

“We need to make it absolutely clear that we still want to work under the larger umbrella of a physician practice, but are seeking more autonomy in our clinical work,” he said. 

Areas for further study include a correlational experiment to measure adverse patient events in relation to PA autonomy, and a survey of physician perceptions of PA autonomy. 

References

  1. Cawley JF. “Research in Action: Levels of Supervision Among Practicing Physician Assistants.” Presented at: AAPA 2015. May 23-25, 2015. San Francisco, California. 
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