The aging of America's doctors, rise of physician assistants
Amid doctor shortages, especially in rural areas and specialties like primary care, veteran doctors are an important component of U.S. health care.
Last year, 22 percent of doctors seeing patients were 65 or older, according to an article in the “New old age” series published by KFF and The New York Times.
But researchers have documented “a gradual decline in physicians’ cognitive abilities starting in their mid-60s,” says Thomas Gallagher, an internist and bioethicist at the University of Washington who’s studied late-career trajectories.
So a few health organizations have established late-career practitioner programs mandating that older doctors be screened for cognitive and physical deficits.
However, “a federal lawsuit, along with the profession’s lingering reluctance, appears to have put the effort to regularly assess older doctors’ abilities in limbo,” the article says.
Meanwhile, the number of physician assistants is increasing.
When the role was created in the 1960s, physician assistants were intended to help expand access to health care in rural America by acting as an “extra right hand” for doctors, performing routine tasks, like taking patient histories and performing physical examinations, under the close supervision of a doctor, says a separate Times article.
Now PAs practice in every medical specialty and with far more independence. So it’s important to understand the differences between doctors and PAs.
Doctors spend about four years in medical school and an additional three to seven years receiving specialty training; physician assistants typically attend a two- to three-year masters program.
In most of the United States, PAs still are legally required to work with oversight from a doctor. But just how closely a PA does work with a doctor depends on the medical specialty, state laws and the individual practice.
In surgical specialties, PAs often work alongside doctors.
But in primary care, physician assistants have much more autonomy, says the Times. They can diagnose, prescribe medication and create management plans without a doctor. In some states, the doctor must be within 30 miles of where the PA is practicing; in others, the doctor can be remote with little or no mandated checks.
The American Academy of Physician Associates, a professional society representing PAs, recently has pushed to untether the profession from doctors and to change the title from physician assistant to physician associate.
Research is inconclusive on whether patients receive the same quality of care from PAs as from doctors. But some experts note that the question is moot, since many Americans don’t live where doctors are easily available. What matters is access to any provider at all.
By the way, PAs shouldn’t be confused with nurse practitioners, another growing group of nonphysician providers who similarly have the authority to prescribe, diagnose and manage care, says the Times.
The two providers typically attend masters programs that are about the same length, but NP programs tend to be more specialized in one area of focus, whereas PAs are taught a more general curriculum that’s modeled on medical school.
Nurse practitioners also have much more autonomy to practice without a doctor’s oversight after they graduate. More than 20 states let NPs prescribe, diagnose and treat patients without doctor supervision, and more than a dozen more only require doctor oversight for writing prescriptions.
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