Physician assistants on the rise as Americans welcome ‘old-time-doctor relationship’

Dean Olsen

With sidebar.

A bad case of poison oak that didn’t improve after Sarah Jones’ initial visit to Springfield Clinic Prompt Care landed the Rochester woman in Carol Harper’s office.

While not a doctor, Harper noticed Jones’ swollen face immediately and quickly handed Jones an antihistamine pill that helped relieve her discomfort.

Because of Harper’s “sweet personality” and good judgment, Jones, a special-education teacher, says she often asks for Harper when she seeks medical care at the Wabash Medical Center offices that Harper shares with family medicine specialist Dr. Geoffrey Bland.

Jones, 49, says she has been pleased with Bland in the past but has enjoyed spending time as a patient of a physician assistant.

“She’s very kind and asks the right questions,” Jones says of Harper. “She’s patient and very caring. She remembered I lost my mother recently. I enjoy that human side of her. It’s just like the old-time-doctor relationship.”

Harper, 44, a former X-ray technologist who received her PA training at the University of Nebraska, said of being a physician assistant, “We pretty much do what the doctors do.”

She has worked as a physician assistant for more than eight years.

The number of PAs nationwide is growing.

A shortage of primary-care physicians, growing numbers of uninsured Americans and an aging population that needs more health-care services are fueling the demand, according to Nancy Hughes, a vice president at the Virginia-based American Academy of Physician Assistants.

PAs don’t complete medical school or residencies. Instead, they go through two-year programs capped off with a bachelor’s or master’s degree. Their academic and on-the-job training allows them to practice high-quality medicine under the supervision of a doctor, Hughes said.

And while the pay is good for PAs — ranging from $60,000 to $100,000 a year in Springfield — they aren’t nearly as expensive for clinics and hospitals to hire as doctors, Hughes said. Federally funded health clinics, designed to serve low-income people who are either uninsured or covered by Medicaid, also make heavy use of PAs.

The PA profession originated in the mid-1960s with former Vietnam War medics who were interested in finding a way to use their training in civilian life. Doctors designed the training programs at a time when there was a shortage of primary-care doctors.

The opening of more PA programs, trends in health care and a greater acceptance of PAs have led to increases in their numbers, and an estimated 50 percent more PAs will be needed by 2014.

Thirty to 40 PAs work in Springfield, handling everything from writing prescriptions after checkups in the office to preparing patients for angiograms and sewing up incisions during heart surgery in hospitals.

“They are becoming harder to find as the physician shortage comes upon us,” said Mary Stewart, an assistant administrator of Springfield Clinic.

PAs are trained differently from nurse practitioners, which are registered nurses with advanced nursing degrees, but the two types of health-care professionals function in similar ways in Springfield and the rest of Illinois because they all are required to be either supervised by or work in collaboration with physicians.

“They really do complement a physician in many ways,” Stewart said.

PAs and NPs expand the number of patients a doctor’s office can serve, and the doctor is close by in case another opinion is needed on a difficult case, Stewart said.

Doctors and patients have become more accepting of these “mid-level providers” over the years, she said.

Dr. Marc Shelton, a cardiologist with Prairie Cardiovascular Consultants, said Prairie employs about 15 PAs, double the number compared with a few years ago.

He said Prairie doctors decided to hire more PAs, who receive additional training from Shelton, in large part to help the doctors better care for patients brought to the hospital with shortness of breath or irregular heartbeats.

The PAs help busy cardiologists assess the condition of these inpatients. And if the patients need procedures such as angioplasty, Shelton said the PAs help prepare patients so they can more quickly receive those procedures from cardiologists. PAs also take care of Prairie patients during some outpatient checkups, Shelton said.

“There just aren’t enough doctors to see everyone when they’re sick, and we’re all working as many hours as we can,” he said. “I think the PAs are helpful, but we do train our own people. The public shouldn’t worry.”

Physician assistant Anthony Grasch works with cardiothoracic surgeon Dr. Stephen Hazelrigg in treating patients with lung cancer and heart problems. He helps Hazelrigg in surgery and occasionally has to give patients bad news.

Grasch said his job has taught him to “appreciate life.”

Physician assistant Jennifer Blase said she tries to make surgeon Dr. Max Hammer’s job easier in the operating room.

“I’ll close the incision and apply dressings,” she said.

Blase, 24, also sees patients in the office, and goes on hospital rounds with Hammer, which often means patients will talk with both of them.

“We just mesh well together,” Blase said.

She said she became interested in the PA profession when her mother, a registered nurse, suggested the option.

“She didn’t think I would be a good nurse,” Blase said. “She didn’t think I had the empathy it would require.”

She said she considered trying to become a doctor, but the lengthy schooling and the lifestyle didn’t appeal to her, especially if she wanted to marry and have children someday.

“I didn’t want to do it all,” Blase said. “I just didn’t want all the responsibility.”

Patients generally address PAs by their first names and find that PAs can spend a little more time with a patient than a physician.

Harper said new patients occasionally question her qualifications, but most appreciate the extra time she takes with them.

A poll done by the American Academy of Physician Assistants showed 90 percent of patients who had been treated by a PA would be willing to use one again.

PAs are respected by most doctors and don’t try to take their place, said Sherie Turner, president of the Illinois Academy of Physician Assistants. “We know our limits,” said Turner, who works at primary care clinics in Mason City and Havana.

To Dennis Rendleman, the health care he receives from Harper and Bland is “seamless. Working with Carol is working with Geoff.”

Harper has treated Rendleman, an assistant professor of legal affairs at the University of Illinois at Springfield, for migraine headaches, sinus problems and allergies.

Rendleman said he and his wife, Barbara Shelow, often don’t remember whether Harper or Bland has treated them, adding, “We don’t think of it as a different doctor.”

State Journal-Register

Dean Olsen can be reached at dean.olsen@sj-r.com.

SIDEBAR

Mid-level practitioners

- Physician assistant, or PA, is the fourth-fastest growing occupation in the Unites States, behind home-health aides (first), data-communications analysts (second) and medical assistants (third).

- There were 29,330 PAs in the United States in 1996 and 63,600 in 2006, an increase of 117 percent. Forty three percent of PAs are men.

- In Illinois alone, the number of PAs has grown 160 percent since 2000 — from 700 to 1,835.

- There are about 115,000 nurse practitioners in the Unites States — 95 percent of them women — and 5,800 NPs in Illinois.

- Springfield Clinic employs 36 nurse practitioners and 12 PAs, and the clinic is looking to hire 13 more of either type of worker.

Sources: U.S. Bureau of Labor Statistics, American and Illinois academies of Physician Assistants, American Academy of Nurse Practitioners, Illinois Department of Financial and Professional Regulation and Springfield Clinic.