NPs and PAs are going to be needed if this country wants to provide insurance coverage to the 40 million uninsured people. PAs have been and are being ignored in these important health reform discussions because of a misunderstanding of what they do. Unfortunately the title "physician assistant" translates to some individuals as a "doctor's helper" Nothing could be farther from the truth. PAs are very much autonomous practitioners who take responsibilty for direct patient care. The role of the supervising physician is much more akin to a consultant available to back the PA up when the need arises. PAs are making a real difference in primary care delivery and are being championed by patients and physicians alike. The importance of increasing the medical workforce with NPs, PAs and primary care physicians is going to be an imperative if we are going to see the Presdent's health refrom plan survive. This is an absolute that deserves Congress's attention.

In point of fact PA's can prescribe medications in all 50 states,the last being Mississippi about 5+ years ago.

Seventeen years ago, there were only 53 accredited Physician Assistant programs in the USA; today, there are over 138. These programs are strict and regimented, undergoing frequent accreditation evaluations with the ARC-PA. Moreover, PAs have the strictest requirements of all medical professionals in order to maintain their license/certification. Following the initial passage of the national board exam, PAs are required to accumulate 100 hours of continuing education every 2 years, with some credits being strictly pharmacology credits to ensure safe prescribing of medications. Additionally, PAs have to pass a national recertification exam every 6 years! This is above and beyond any other health profession. The educational model is different than CRNPs who follow a nursing models; PAs are taught in the medical model, just like physicians, and often clinically rotate through various specialties along with medical students and residents. PAs have a close working relationship with physicians and have often been referred to as physician-extenders. Patient education, disease prevention and disease treatment are all foci of the plan of care. There have always been different approaches in the treatment of patients, and one particular approach may not be the right one for everyone. There is room for physicians, PAs and CRNPs, with the decision being left to the patient as to his/her preference. PAs are at least equal to CRNPS in capability and should be given equal venue!
For more information including a history of the profession (very interesting), one should go to the American Academy of Physician Assistants website at www.aapa.org. The Maryland Academy of Physician Assistants also has its website, www.mdapa.org.

Thank you to the editors for acknowledging and addressing Physician Assistants (PAs) and their potential role in health-care reform. But I am appalled about how little the public knows about the PA profession. PAs evolved in 1960 via the military because of shortage of physician. Unlike a nurse they are taught using the medical model as opposed to the nursing model. PAs are required to be assigned to a supervisory Physician. But work with total autonomy. Having a physician to verify skills discuss difficult patient enhances a PAs ability to provide high quality medical care( not nursing care). In 2008 approximately 257 million patient visits were handle by PAs. PAs are also highly skilled for example PAs are performing more invasive procedures then non-surgical physicians. They are skilled and perform central line placements, arterial lines, ventriculostomies, lumbar punctures, para and thorocentesis, vein stripping and harvest, assist with surgical procedures even in the position of first assist as well as suturing and other invasive procedures. PAs have prescriptive authority all the states to include the District of Columbia and in Guam. In fact approximately 332 million medications were prescribed or recommended by a PA. There are several studies that show the positive impact mid-level providers in particularly PA have had on patient health-care and education. Please consider this information as well as other factual data when writing about the PA profession. The information provided in this comment can be supported by the American Academy for Physician Assistants ( AAPA). There is no doubt PAs could make the essential factor in our ability to provide holistic high quality cost effective health care.

Thank you for this column, any public recognition of PAs is a step in the right direction . I hope you will write an extended piece in the future on PAs!

Suggestion:
Posting a draft about new goverment positions for PCPs, PAs, CRNPs to know their interest in moving from HMO ManageCare to Obama's new community jobs indicating job description, salary, beneficts.Teaching rounds at Medical Schools and back to old physician-patienet relation. Morning medical discusions instead of company profits. Sure, for them also takes time to make a decision!

I can't say enough about my nurse practitioner. She has stood by me through thick and thin, has always been easily accessible, quick to respond and, many times, quick to comfort and/or reassure. She recently left one practice to join another and I will follow her because my allegiance is to her, not to the doctor, whom I might have seen 3 times in the more than 5 years I saw my NP. Having known several NPs over the years, not always in the role of a medical professional but in other roles, I have nothing but good things to say about these folks who are truly more dedicated to their patients than many doctors. They are always there for me.

How many primary care physicians actually use PAs? Since PAs can only work under the supervision of a physician, how many doctors actually want to increase their patient load (and legal responsibility) in this manner? PAs are NOT the answer to a primary care physician shortage. That's why universal health care insurance is doomed to failure.

PAs are indeed the answer to the shortage of PCPs (primary care provider) in the US. PAs require "supervision", but more along the lines as consultation than anything else. A PCP can employee 2 PAs in their practice, making it much more lucrative for that PCP to run a higher patient load (which, by the way, most PCPs want higher patient loads as long as delivery system is profitable & efficient), with the guarantee of satisfied patients. Patients have been reporting to truly appreciate the quality of care the PA provides vs. the typical rushed visit with their physician. PCPs can focus on the more complex cases, possibly enhancing satisfaction of their career choice of primary care over a specialty. For many of the typical services provided in a primary care setting, there is no legitimate reason for a PCP practice not to have PAs provide those services. How does this help the economy and argue for healthcare reform? By increasing access to and lowering the cost of providing primary health care; by improving both preventative care services as well as care of chronic illnesses (ie, diabetes & high blood pressure). Just by improving those 2 areas alone can reduce overall healthcare costs (ie, keep patients healthier and out of the hospital). Healthcare reform in the US is inevitable and by utilizing resources that already exist such as PAs, it can and will succeed. It can truly be a win-win for provider, payor and patient. The problem right now lies more in the fact that too many politicians and people are creating unnecessary fear in the public by demonizing and lying about healthcare reform, with the focus on the term "universal” healthcare. Many variable ideas and programs are being debated, least of which is a wholly single government-only-you-have-no-other-choices coverage system. Perhaps we need to stop calling it "universal" healthcare since it erroneously implies to many people as a single option for coverage. What healthcare reform is truly about is changing the current system to something better. For excellent reading about this issue, I suggest Senator Max Baucus's Call to Action paper issued in 2008.