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What About Physician Assistants?Richard Cooper offers solutions for the impending physician shortage (Nov/Dec 04). He mentions the larger role that nonphysician clinicians could play in diminishing this shortage but contends that there is insufficient evidence to justify an expanding role. We believe that physician assistants (PAs)—and others, such as nurse practitioners—can offset this shortage. Although we also call for more research on the relative merits of alternative physician/PA team models, there is ample research to justify expanding the number of PAs to fill roles where their cost-effectiveness, productivity, patient satisfaction, and quality of care have been consistently documented. The physician shortage could be minimized by training and employing larger numbers of PAs to assist physicians with routine tasks. Indeed, team care is the most rational solution to the growing burden of chronic disease management. Instead, Cooper, like many other observers, leans toward expanding the physician work-force, although he notes several obstacles. But enlarging the PA workforce would avoid many of the obstacles. (1) The PA training pipeline is much shorter than that of physicians (on average, just over two years). (2) While Cooper reports that there are 1.3 medical school applicants for each available medical school space, there are more than two applicants for each available PA space. (3) It costs less than $50,000 to train each PA, which is a fraction of the cost of educating a physician. (4) Since PAs are trained as generalists, they remain flexible throughout their careers and readily adapt to changing health care system needs. We join with Cooper in his call for foundation support for interdisciplinary research on team models of care. We assert, however, that for PAs and some other nonphysician professions, existing evidence already warrants that they be given an increased role.
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