New state law paves way for physician assistants to practice more widely

Monday, August 12, 2013 | 1:13 p.m. CDT; updated 9:02 a.m. CDT, Tuesday, August 13, 2013

COLUMBIA — Lindi Farmer always wanted to work as a physician assistant in a rural area.

What made it difficult were legal restrictions that required close, time-consuming oversight. Doctors in rural areas often shied away from hiring people like Farmer because of the burdensome requirements.

Under existing Missouri law, a supervising physician must be within 30 miles of sites where physician assistants provide care. The doctor also must be present 66 percent of the time the assistants are caring for the patients.

A new law to take effect Aug. 28 relaxes those requirements. The change allows  supervising physicians to practice within a 50-mile radius and spend just four hours every 14 days supervising the physician assistant providing patient care.

"In rural areas, you might not have very many providers," Farmer said. "This law helps that a lot."

Farmer has been a physician assistant at Macon Medical Clinic for two years. She encountered difficulties finding a job when she first began applying for work, before she started working at the clinic in Macon. Two jobs she applied to hired nurse practitioners instead, who had more leeway with supervision requirements.

"It was disheartening because I see that we are all mid-level medical practitioners," Farmer said. "No one should be losing out on a job."

Even some of her friends would ignore the job market in Missouri because of the strict supervision law, she said. Job opportunity was there, but the likelihood that a physician assistant would land the position was slim. They, instead, moved to neighboring states where the restrictions weren't as heavy.

"I feel like now we're more on an equal playing field," Farmer said.

The Affordable Care Act, which passed in 2010, caused a shortage of primary care doctors after expanding health care benefits to millions of Americans.

Medical professionals are likely to be in higher demand once coverage becomes available to more people and other services become an option to those already insured. Rural health clinics in Missouri will soon be able to hire physician assistants who will have the freedom to see more patients when the physician is out of the office.

"This can open up possibilities," said the president of the Missouri Academy of Physician Assistants, Paul Winter.

The current law, which has been in effect since 2006, not only limits the job market for physician assistants, but has also forced patients in rural areas to visit urgent care clinics and the emergency room when physicians were unavailable.

The Missouri State Medical Association, Missouri Family Practice Association, Missouri Association of Osteopathic Physicians and Surgeons and other physician groups sent representatives to the state capital testify in favor of the bill, Winter said. There was no opposition in either the House of Representatives or the Senate, Winter said.

Even though Farmer said her supervising physician will continue his oversight even when the law is in place, the change has opened new horizons for physician assistants.

"The biggest change is equality," Farmer said. "Now the whole state is recognizing that we're all mid-level practitioners."

Supervising editor is Jeanne Abbott.

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