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Musings: Blog of the JAAPA Editorial Board
Monday, September 01, 2014
More questions than answers
Wanda C. Gonsalves, MD

One thing we know for sure is that our healthcare system is fragmented, expensive, and heavily regulated. As a result, we’ve been trying to fix the problem by creating new models of care. Two such models are the patient centered medical home and the direct primary care model, which are totally different approaches to primary care practice: the former is team-based and the latter retainer-based.
 
In the response to the cost of care and a physician shortage that threatens patient access to care, the number of physician assistants (PAs) and nurse practitioners (NPs) has soared, as have the number of programs that train them. Healthcare administrators have seen the benefits of adding PAs and NPs to their medical teams because they provide care at lower cost. Adding PAs and NPs frees up physicians to see more patients and to concentrate their efforts on more complex patients.
 
Medical schools across the country have responded to the physician shortage by increasing their student enrollments or looking for innovative training models. A few medical schools are exploring options to respond to the high cost of medical education by shortening medical school to 3 years. Examples include the Texas Tech University Health Sciences Center School of Medicine in Lubbock and Mercer University in Savannah, Ga.
 
The increasing medical student enrollment and the changes in medical education may have many effects on the PA profession and PA education. How will the increase in medical students and PAs and NPs alter the healthcare workforce? Is the number of PA programs expanding too quickly? Will fewer PAs enter the profession if the length and therefore the cost of medical education are lowered? Will the increase in medical students reduce the availability of training sites such that PAs and NPs will have less of an opportunity to practice what they are learning?
 
Only time will tell about the workforce issues. However, across the country, the availability of training sites has become quite competitive for all learners. Many medical schools are paying physician preceptors for taking students, ultimately increasing the cost of tuition and the cost of healthcare. I don’t have all the answers. The PA profession should begin to address these issues that threaten to be with us for some time. I suggest that the PA leadership and physicians work together to answer questions about how PAs might optimally fit into these practice models and others so we can help guide our practice, rather than be the last to the table.
 
Wanda C. Gonsalves is vice chair of the Department of Family and Community Medicine at the University of Kentucky in Lexington. She also is a steering committee member of Smiles for Life, a national oral health curriculum. The views expressed in this blog post are those of the author and may not reflect AAPA policies.