Jerry Kopel

KOPEL: DOCTOR SHORTAGE HITS HOME

Nurses, PAs could augment primary care for the medically underserved in Colorado

There are now nearly a MILLION of them.

A million what or who? Active physicians in the United States.

The Association of American Medical Colleges tells us that only 350,000 doctors are primary care physicians, and they are the doctors most needed by our populations. By 2025 this country will be short 150,000 physicians including 45,000 to 60,000 primary care doctors.

Researchers at the Dept. of Regulatory Agencies recognized the coming shortage and suggested how to reduce the shortage. You will find it in House Bill 1260 sponsored by Rep. Jim Riesberg, D-Greeley, and Sen. Betty Boyd, D-Lakewood, to continue the Colorado Medical Board under the 2010 Sunset review.

A recent Wall Street Journal article on underserved states gave Colorado, Nebraska, North Dakota, California, Oregon and Washington as the only western states with more than three primary care givers for every 2,000 residents.

Despite that enviable position DORA is accurately claiming, “since Colorado already has a high number of underserved… the shortage can be expected to impair Colorado particularly hard.”

One alternative is to expand the use of physician assistants (referred to as “PA” in this column.) Licensing approval under the new law comes from a three-member subset of the 13-member medical board.

As of fiscal year statistics ending June 30, 2008 there were 1,650 PAs. The possible use of two PAs per doctor in state law was doubled in HB 1260 to four per doctor. Wise use could result in 6,000 PAs, many available in rural Colorado areas and possibly more if waived by the board.

What do PAs do?

PAs practice medicine under supervision and direction of physicians. They take medical histories, conduct medical exams, diagnose and treat illnesses, order tests, assist in surgery and prescribe medicines.

DORA explains, “PA education entry programs typically require two to four years of undergraduate education and some experience in health care. The PA program is two years long. It includes instruction in biochemistry, pathology, human anatomy, physiology, microbiology, clinical pharmacology, clinical medicine, geriatric and home health care, disease prevention, and medical ethics.”

PAs must be at least 21 years old. The PA cannot practice without a PA license from the proper authority.

There is a national test for PAs seeking certification on almost a daily basis in Pueblo, Greenwood Village, and Westminster. It is a six hour multiple choice of 360 questions of medical and surgical knowledge.

One important amendment placed PAs under the same standards of liability as doctors for practice. PAs thus are liable for discipline under categories that formerly applied to the practice of medicine by doctors.

Another source of additional help for the underserved are nurses. A minority of nurses presently has the right to prescribe medicines. The Associate Press reports 28 states could expand nursing authority.

The American Medical Association holds a doctor shortage is no reason to put nurses in charge and endanger patients. “Nurses state they spend more time with patients and charge less. Studies found little difference in quality.”

Colorado is a state that permits certified nurses the right to overcome statutory barriers and have the right to prescribe after approval from the state nursing board. That includes additional authority under SB 138 by Sen. Boyd and Rep. Sara Gagliardi, D-Arvada.

The question in Colorado is whether in the future Colorado doctors will recognize that even with more PAs they will still need the help of thousands of nursing practitioners.

Jerry Kopel served 22 years in the Colorado House.