How PAs, APPs Expand Patient Care Access, Patient Satisfaction

In her over 30 years as a physician assistant (PA), Dawn Morton-Rias, Ed.D, PA-C, has never had a patient decline her services and ask for a physician, although she’s sure to always make clear she isn’t one. That’s because PAs tend to generate high patient satisfaction and help patients get appointments sooner, making the case for PAs to meeting patient care access needs.

“That's the experience pretty universally across the board for more than 150,000 certified PAs in the US, and another couple hundred abroad,” Morton-Rias, the president and CEO of the National Commission on Certification of PAs, told PatientEngagementHIT.

“We speak very freely about who we are, what our role is, and how we complement the entire healthcare system by making healthcare accessible to more than 9.9 million patients a year. That's a tremendous number of patients that are seen by PAs throughout the course of a year, and it works out well.”

As the healthcare industry stares down an looming physician shortage problem—AAMC predicts the US will be short between 37,000 and 124,000 physicians by 20134—filling in those gaps will be crucial. Without enough physicians to see every patient, the nation runs the risk of having some go without care.

And as is generally accepted in medicine, when patients miss out on primary or preventive care and chronic disease management, they’re likely to have a higher acuity episode that is both more costly for the industry and more harrowing for the patient.

Advanced practice practitioners are going to be instrumental in filling that gap, Morton-Rias asserted. Between PAs and nurse practitioners, APPs can meet basic medical needs, largely because they’re trained in the same hard sciences as physicians and follow the same medical model.

But as the debate around scope of practice continues, Morton-Rias emphasized the importance of role distinction. Ensuring the patient knows the credentials of the clinician seeing her—MD, PA, NP—is a fundamental tenet of patient safety and a basic patient right. And as she noted above, it’s never been a problem in her patient-provider relationships.

In fact, her training and work as a PA is a significant strength as she treats her patients, she said.

“When patients are reminded that we are PAs, they're always pleased to say, ‘Wow, you really provide great care, and you're not a physician,’” Morton-Rias said. “It's remarkable how that perception of who's providing the care changes throughout the course of the experience with the patients.”

Specifically, Morton-Rias said patient satisfaction with PA-led care is high. NCCPA has done a number of studies assessing patient satisfaction with PAs, finding that more than 90 percent of patients surveyed on the matter were satisfied or very satisfied with the care they received from a PA.

“Why were they satisfied? They were satisfied because, first and foremost, their medical needs were addressed,” Morton-Rias noted.

This tracks back to the traditional PA training, she said. PAs study many of the same hard sciences that physicians do, and follow the same exact medical model as physicians, allowing them to create a care experience that similar to what a patient might receive from an MD.

“Second of all, the patients were likely to get an appointment earlier than expected,” Morton-Rias continued. “If they were waiting to see the physician, the appointment might take longer to get, and so they were able to get earlier appointments.”

“They felt that they were able to spend more time talking with the PA, learning more about what their problems were, being educated on how to care of themselves when they're not seeing the provider, and feeling that they were cared for and attended to medically, as well as interpersonally,” she added.

That doesn’t mean it’s always clear to patients who their provider is, Morton-Rias acknowledged. Although she holds a doctorate, her degree is not an MD, so she never introduces herself as doctor and always clarifies that she is a PA.

“We're very clear,” she stated. “Role identification is very important in our profession, because we don't want patients to be confused, but we want them to feel confident that we've been educated with physicians and in that medical model like physicians, which is why they think of us as physicians, because we do the same things and we conduct the same types of interviews.”

But even so, it is not uncommon for Morton-Rias to conclude her physical exam and hear the patient say, “thanks, Doc.” When that patient does conflate her as a PA with other physicians as MDs, she is sure to clarify the distinction but is careful not to discredit her own capabilities and training. After all, she still needs the trust and confidence of the patient.

“We often tell the patient that we are educated in the medical model, which means our education looks very much like medical education, heavy basic sciences, clinical sciences, full-time curriculum, clinical rotations in all of the specialties and disciplines, inpatient, outpatient, emergency, et cetera,” Morton-Rias said, offering some scripting for other PAs encountering the same patient confusion.

Additionally, she assures the patient she can provide about 70 or 80 percent of the same services that might ordinarily be provided by a physician. Critical to this is emphasizing the team-based partnership between PA and physician.

“We reassure patients we're educated in that same model, and we work closely with physicians, so that if their case is unique in some way or extremely complicated with multiple comorbidities, we consult with physicians,” she explained.

Again, this distinction has never been a problem for Morton-Rias, who is seasoned in her profession. PAs and NPs are associated with high patient satisfaction and clinical quality scores, and anecdotally patients tend to like getting care from APPs.

And in fact, Morton-Rias said her training as a PA, as opposed to an MD, gives her opportunities for building deep patient-provider relationship. For example, her patient load as a PA affords her the opportunity to dive deeply into patient education.

“Our communication skills and our interpersonal exchange with patients is unique,” Morton-Rias said, acknowledging that other providers also focus on education, too. “But when we move through the exchange with the patient, they feel very much like they're being seen by a physician, but what's unique is our ability to care for and attend to the patient in an interpersonal way, with a little more time, a little more attention to their needs, communication wise.”

Patient self-management is one of the hallmarks of good PA care, Morton-Rias noted, as most patients with chronic illness see their providers at most about once each month. Patients need to have the skills to take care of themselves outside of the clinic, and Morton-Rias said PAs are in a good position to teach them those skills.

What’s more, PAs have the time to integrate more social determinants of health work into their medical practice. Again, this is essential for helping patients with self-management outside the clinic.

“We see it as our job to help empower the patient to make healthier choices, to make good decisions, to understand their condition and how their social determinants, their lifestyle, their behaviors all influence their health care,” Morton-Rias explained.

“Cultural competence and communication skills are ingrained in our profession and in our education,” she added. “We are committed to working with patients from all walks of life.”

Part of that commitment is building out representation within the PA profession so that PAs reflect more of the culture of America. This is a key driver of health equity, most experts agree, and data has shown it can help improve the patient experience.

“But even when we are racially or ethnically different from patients, again, our education and training really guides us to not only provide that great care and to communicate well, but also to advocate for patients, to speak up for them,” Morton-Rias said.

Ultimately, it is those foundational principles of the PA profession that makes PAs ready to meet an evolving healthcare landscape. As the industry sees the physician workforce shrink and the health equity priority grow, PAs by training are able to fill this gap.

“The PA profession has its roots in medically underserved communities. The profession was created to expand access to healthcare, initially in primary care, outpatient family medicine, in rural communities and urban centers where healthcare services may not have been as readily available for the entire population,” Morton-Rias concluded.

“That's the root of the profession, bringing healthcare to the community. As the profession has grown over the course of 50 plus years, we still hold on to that commitment to the underserved.”