The case for PAs: Why the demand is increasing & how they affect ASC operations

The demand for physician assistants is undoubtedly on the rise with the number of PAs up 100 percent over the last decade, according to the 2014 Review of Physician and Advanced Practitioner Recruiting Incentives by Merritt Hawkins.

With the increase in the number of people with access to healthcare, as well as the looming physician shortage, it is not difficult to see why deconciliisphysicians are looking to PAs to help provide care. Physicians providing care in the fast-paced and typically lean environment of an ambulatory surgery center may also be able to see added benefits to having the support of a PA. "Physicians who have PAs working with them, their day will be more efficient, and they will be able to see more patients," says Greg DeConciliis, PA-C, CASC, administrator of Boston Out-Patient Surgical Suites.

Reasons behind the increase in PA demand
One of the most pressing reasons driving up the demand for advanced practitioners is the impending physician shortage.

According to recent study by the Association of American Medical Colleges in the next 10 years, the United States will need between 46,100 and 90,400 physicians. In particular, the non-primary care physician shortfall will be between 28,200 and 63,700, with the greatest shortages in surgical specialties.

Kube"The anticipated increase in the physician shortage leads to scenarios where we are finding a need for folks who can chip in in the place of physicians," says Richard A. Kube II, MD, founder and CEO, Prairie Spine & Pain Institute, Peoria, Ill., which includes Prairie SurgiCare.

Another major driving factor of this increased demand is declining reimbursements. Being able to see more patients in a day is one way to combat the drop in reimbursements. "As reimbursements go down, a logical step for us to be considering is how to do more with less," says Dr. Kube. "Physicians are trying to come up with ways to be in more than one place at a time and having a PA is one way to accomplish that."

Finally, physicians are looking for better work-life balance, and having a PA helps them accomplish that. "Physicians may want to work less, but still make sure that their patients are getting the care they need, says Mr. DeConciliis.

A PA's impact on day-to-day activities
The increase in efficiency that PAs can provide, especially for ASC physicians, is one of the biggest benefits.

PAs can help complete administrative tasks that take up time, thereby allowing physicians to spend less time with patients and perform more cases, according to Mr. DeConciliis. They can also help set up the operating room prior to surgery and close a case, while the surgeon goes on to the next case.

"PAs can also improve patient satisfaction by spending time with patients to ensure they know what they should expect post-operatively and they can even perform follow-up calls to make sure the patient is happy the day after surgery," says Mr. DeConciliis.

According to Dr. Kube, having a PA allowed him to expand service lines at his facility. Prairie Spine & Pain Institute now treats patients with severe headaches and other chronic pain pathologies. "And I have been able to expand without ignoring the surgery patients," he says. "The changing healthcare industry wants physicians to be able to treat chronic diseases. It has been a major benefit for us to be able to deliver a more comprehensive suite of services to patients."

In addition, PAs can provide a helping hand in the operating room at surgery centers. Having a person you trust in the operating room is invaluable, particularly in an ASC where extra technicians or support staff may not be available if needed as in hospitals, says Dr. Kube.

"Having a PA is important if you are performing procedures at an ASC regularly, especially with the advent of minimally invasive outpatient spine surgery which is complex and can require extra clinical support," says Dr. Kube

PAs have a great deal of autonomy and a fairly vast scope-of-practice, under the supervision of a licensed physician. However, it is important for physicians to know the clinical and professional limits of the PAs they are supervising, says Dr. Kube. Typically, a PA's scope of practice differs from state to state.

"Overall, I think as a physician, having a PA is fantastic," he says. "It allows me to do more at one time, helps me to cover cases and helps me see more clinic cases. I like being able to see my patients and a PA helps me do that without pushing myself to the brink."

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