Letter to the Editor: The Arizona Physician Shortage - Time for New Ideas

Letter to the Editor: The Arizona Physician Shortage - Time for New Ideas

Arizona is in for a big problem. We are experiencing a physician shortage that will only get worse. By 2030 our state will need almost 2,000 more primary providers. Increasing and aging populations, lack of rural providers, lack of medical residency slots, retiring providers and the expensive cost of medical training are all part of the problem. Arizona will need new ideas and practices to fill this gap.

According to US News and World Report, Physician Assistants are #3 in the 100 Best Jobs and Nurse Practitioners are #4. Both earning an average of over $100,000/year. Physician Assistants (PAs) have been around since 1967. Started by a visionary doctor, Eugene V. Stead, he saw the need to fill the gap in rural practice which sends well trained providers to underserved areas. He selected Navy Hospital Corpsmen who received considerable training from their military service and based his curriculum on his knowledge of the fast tract training for doctors in World War II. The military continues to train PAs and there are 3 programs in Arizona and many more across the country and in neighboring states. In Arizona there are over 1,000 certified PAs and over 115,000 in the US. The profession has expanded to Europe and other countries around the world. I was very fortunate ten years ago, to bring the profession to England and practiced there, learning about their Universal Healthcare system intimately, as a provider and a patient.

Nurse practitioners also practice widely throughout Arizona, providing care in rural areas, Indian Health Services and in the prison system along with PAs. They practice by collaborating with physicians and providing many medical tasks, including anesthesia during surgery ( CRNA) first assist in the OR (RNFA) and as midwives (CNM).

The Physician Assistant national academy (AAPA) authorized in 2017 “Optimal Team Practice” that will keep together the benefits of a team without the legal risks and administrative burden of supervisory restrictions that were initially devised for PA practice. This is not collaboration but better, it will enable PAs to care for patients without the physician being responsible for PA provided care. The PA role is well established after 50 years and well respected. PAs will continue to consult, collaborate with and refer patients to doctors as they have always done. The hallmark of PA practice is not independent practice but to work with other providers in a team setting, with the physician and other players who are integral to good medical care.

When I became a PA in the early 80s I had to make my own job. I graduated from the first class at the University of Southern California ( USC )which had to pay tuition. PAs were just starting out and I had to convince and educate doctors about my value, training and professionalism. Now, over 35 years later, everyone knows a PA or NP and respects and understands our training and important commitment to providing exceptional healthcare. PAs and NPs and other advance practice providers are excellent solutions to our healthcare shortage needs. Training takes less time, costs less and expands practice everywhere. But it is important that these professions remember their roots. They were devised to fill an important role in healthcare. Providing medicine to rural and underserved areas all across our country.

Unfortunately, due to the high cost of tuition, and exciting inducements of specialty practice and increased salaries in urban areas, PAs and NPs tend to congregate in large cities. We must work with lawmakers to find ways to reduce the cost of training programs, expand programs, loan forgiveness and tuition reimbursement incentives to non-physician providers, including nurses, to relieve shortages.

Our problems of shortages will not resolve until we develop more innovative care models. PAs and NPs can provide 80% of the care provided by doctors. The other 20% is so specialized that the average patient may never use it in the course of normal, primary care. PAs and NPs work in the wilds of Alaska, the outer banks of the Carolina’s, Indian reservations, all prison settings and even in the White House. Expanded telemedicine, providing medical transportation from rural areas to specialized centers and increased training models must be implemented. We cannot wait, the health of our state rests on our recognition and swift, creative solutions. Lawmakers must be dedicated to addressing and remedying these issues. Affordable, accessible healthcare for all is a human right and must be a paramount priority for all citizens of Arizona.

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