New law to ease doctor shortages

Bill allowing physician assistants to work alone awaits approval
Tuesday, May 8, 2007 | 12:00 a.m. CDT; updated 7:06 p.m. CDT, Tuesday, July 15, 2008

ROLLA — Tracy Parsons keeps busy seeing a slew of patients with typical pressing health issues, including fevers, gashed fingers and ear infections.

Parsons isn’t a doctor; she’s a physician assistant. But her training, while shorter, is more similar to medical students’ than nurses’.

Physician assistants such as Parsons could have been forced to scale back their work if lawmakers had not stepped in this year.

Under current state rules, doctors technically are expected to be in the same building as their physician assistants at all times, but there’s a big loophole. Assistants practicing in “health professional shortage areas,” as designated by the federal government, only need a doctor within 50 miles — not on site.

About 89 percent of Missouri counties have at least some shortage areas, according to the U.S. Department of Health and Human Services.

The Board of Registration for the Healing Arts, which regulates doctors, physician assistants and other health professions, had believed a federal law allowed for the on site exception. But it determined last summer that Missouri did not qualify for that exception.

As a result, the board expected to revert to requiring doctors be constantly on site monitoring physician assistants as of Aug. 28, the day most state laws take effect. Some feared the change could force clinics to slash hours or close entirely, especially in rural areas where clinics may have only one doctor and assistant on staff.

“Some patients would have lost access to health care or had to travel farther,” said Parsons, who works at a St. John’s Clinic in Rolla.

But the physician assistants and doctors’ lobbying groups worked together to reach compromise legislation. It won final legislative approval in the Senate on April 30 and now awaits the governor’s signature.

The bill puts into law guidelines for monitoring physician assistants, requiring doctors to be on site at least 66 percent of the time. The rest of the time, the doctor must be reachable by phone or other means and no further than 30 miles away.

But it also provides for a waiver process, so teams of doctors and assistants can apply to practice outside those restrictions if they’re in a designated shortage area. The doctor would need to be within 50 miles of where the assistant is treating patients, and they would need to show that patients’ access to medical care would be limited without a waiver.

Missouri has about 400 physician assistants. They generally have a bachelor’s degree and complete a master’s program, akin to the early training of medical school with a focus on diagnosis, but without requirements to complete a residency program, according to the Missouri Academy of Physician Assistants.

Normally, at least one of its four doctors is around the Rolla clinic, Parsons said, but there are times when she is there alone, and if the legislation had not passed, she would have been prevented from helping a sick walk-in patient starting this fall.

Physician assistants have been working to put guidelines into law for how much doctors must be on hand to supervise their work since 1999.

“Putting this in statute will let us do what we have been doing,” Parsons said.

Some patients also are glad physician assistants won’t face tighter restrictions.

Carolyn Cruse was having trouble breathing and came to the Rolla clinic last week. Her regular doctor was out for the day, so Parsons saw her instead. “She’s a real asset to the clinic,” Cruse said. “Sometimes it’s difficult to just really get right in. I’m as comfortable with Tracy. I don’t feel like I’ve seen someone lesser.”

Cruse said there’s no need for doctors to be constantly looking over the assistant’s shoulder, and she’s comfortable that they’re available to consult if needed.

“I don’t feel like they have to be monitoring her every move. She’s very competent,” she said.

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