Valley Voices

A law keeps physician assistants from providing key medical care

Physician assistant Adam Marks examines 4-year-old Azul Michelle Cruz to the Family Health Care Network in Cutler in this file photo. Azul’s mother, Edith Cruz, says her child was showing respiratory problems.
Physician assistant Adam Marks examines 4-year-old Azul Michelle Cruz to the Family Health Care Network in Cutler in this file photo. Azul’s mother, Edith Cruz, says her child was showing respiratory problems. Fresno Bee file

For many of us, finding health care doesn’t pose much of a problem. Through a few mouse clicks and keyboard strokes, we can usually find providers nearby who accept our insurance, read other patients’ reviews, and even make an appointment.

But for the homeless, health care often isn’t an option.

Los Angeles County is home to the largest number of chronically homeless people in the nation. And in 2017, the county’s homeless population increased 23 percent, despite success in placing people in housing. That’s a lot of people who, without adequate financial means or health insurance, aren’t getting the care they desperately need.

Two PAs, or physician assistants, at the Charles R. Drew University PA program set out to help. Katayoun Moini, director of the PA program, and Lindsay Kozicz, associate director of the program, hoped to provide essential primary care services to homeless adults and children in Los Angeles. But along the way, they hit a debilitating roadblock.

Currently, in order for PAs to provide care, California law requires that a physician sign a delegation agreement making the physician legally responsible for the care provided by the PAs. But Moini and Kozicz have been unable to find a physician willing to sign a delegation agreement. Because of this outdated law, two well-qualified providers who want to provide more assistance to an incredibly vulnerable population simply can’t. And that needs to change.

Throughout California, there are underserved communities that would benefit from the care that PAs provide — but restrictive laws are holding physician assistants back.

PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and often serve as a patient’s principal health care provider. PAs practice in every state and in every medical setting and specialty, and there are currently more than 11,500 PAs practicing in California.

PAs are educated as medical generalists at the master’s degree level, in programs that are about three academic years long. The curriculum, based on the medical school model, includes rigorous academic courses and an average of 2,000 hours of clinical rotations.

When restrictive laws prevent PAs from practicing at the top of their education and experience, patients lose out on high-quality care. Medically underserved populations in California, including the homeless, rural communities, and densely-populated urban areas, need better access to care. PAs’ education allows them to be adaptable and flexible in the health care workforce — making PAs a crucial part of the solution for medically underserved communities.

Demand for PAs is high — the profession is expected to grow 37 percent from 2016 to 2026, according to the Bureau of Labor Statistics. More and more students are choosing the PA profession, and in underserved areas with limited access to health care, that influx of PAs can help to fill the gap.

With demand for appointments at an all-time high and a primary care physician shortage looming in California, some practices have long wait times. PAs can make it easier to get an appointment, and PAs in California complete an average of 90 patient visits per week. And that’s good for all patients, not just those with limited access to care.

We need to do all that we can to pave the way for PAs to practice more effectively in California. As the fastest growing health care profession in the country, we need to take advantage of the high-quality care that PAs can provide in California, rather than allowing laws to prevent them from reaching the patients who need them.

Adam Marks, is a physician assistant from Visalia, California who specializes in family practice at the Family health care Network.

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