(COLORADO SPRINGS) — A bill that could increase access for rural Coloradans by expanding a physician assistant’s ability to practice will be heard on the Senate floor on Thursday, March 2.
Physician Assistants (PA) in Colorado are currently experiencing professional difficulties throughout the state because of supervising requirements, according to a member of the Government Affairs Committee, Bryan Wogen.
“We have a lot of employment problems where a physician will leave a group and we are left without a supervising physician. And now not only the PA is out of a job, but also the community is now without providers,” Wogen says.
Wogen who is also a PA and founder of Lykos Medical Primary Care in Colorado Springs says the problem starts with the perceived definition of ‘supervision’ in PA law. According to Wogen, ‘supervision’ refers to a once-a-year review that does not require a standard for criteria or feedback.
Additionally, Wogen states part of the language of supervision is that PA’s, “are not allowed to practice medicine in a way that their supervising physician is also not equally trained or credentialed.”
This means that years of “experience, qualifications and skills,” become irrelevant for PAs wanting to provide medical services without a supervising doctor credentialed in that same field of medicine.
Rural areas of Colorado mostly in the western slope including Durango and Cortez are already experiencing complications as many doctors leave for higher-paying jobs in bigger cities. Wogen calls this phenomenon ‘medical tourism.’
“And those small communities, what are they left with? When the doctor leaves, the PA is back to being shackled and can’t operate,” says Wogen. “It leads to a lot of insecurity from a patient perspective. You don’t know what’s going to happen and it also makes [PAs] very insecure from a professional employment perspective.”
The Physician Assitant Collaboration Requirements bill or SB23-083, aims to change the language from ‘supervising to collaboration,’ thereby modifying the relationship between a PA and a physician – a practice already accepted in many other states, according to Wogen.
“It’s very outdated. The language of the law has not evolved with how the practice of medicine has evolved,” claims Wogen.
This would ultimately increase healthcare access for rural and underserved communities in Colorado by allowing PAs to practice with a more collaborative agreement involving the physician or employer, says Wogen.
However, not all healthcare professionals are in support of the bill like Dr. Ramnik Dhaliwal, MD, JD, who represents the American College of American Physicians and also sits on the legislative committee.
“There’s further solutions that have been proposed that wouldn’t put at risk patient safety, wouldn’t increase cost to the health care system, and wouldn’t increase cost to patients.”
Dhaliwal says access is one piece, but the quality is another.
“When I say quality, I mean cost utilization costs and pretty much the general care that you get. So it shouldn’t be different in an urban area and in the rural community.”
The current solutions proposed by the bill would likely increase costs, according to Dhaliwal.
“There’s been multiple studies, one just in October of 2022, where they showed that PAs without physician supervision actually increased costs 70% when compared to physician-led teams,” states Dhaliwal who points to utilization being the culprit. “… Increasing x-ray use, increasing CT scans, increase in consults and increase in admissions and also repeat visits for similar problems.”
The structure and background for PA education were additional points of contention made by Dhaliwal.
“There was a survey done of program directors… throughout the country and 86% of them felt that school, just school does not prepare students to practice without supervision,” says Dhaliwal. “So even their own educational group does not feel comfortable and feel that it is safe for that to happen.”
Those opposed to the bill would agree with Dhaliwal who claims Colorado’s current model provides patients with not only access but quality and cost-effective care.