DENVER — Colorado legislators hope 2023 is the year they can provide physician assistants (PA) more leeway when it comes to treating patients.
Supporters say the goal is more accessible care.
“I know at this point in my life, I cannot afford another child,” said Heather Sisenstein, a single mom to a 7-year-old daughter.
Sisenstein has been receiving care for years from a PA she’s grown to love in the rural, southeastern Colorado town of Lamar. She went to her doctor to get an intrauterine device (IUD) for birth control.
“Unfortunately at that time, she was not able to do so,” Sisenstein explained. “Her previous supervisor was stepping out, and somebody else was now her supervisor who did not have the certification or knowledge to do that."
She found another doctor who could, but it isn't covered through insurance. Her only option was to travel to Pueblo several times, which is a two-hour drive each way.
“Thank goodness I was able to get that taken care of over the summer, otherwise I would have been pulling my child out of school for that,” said Sisenstein.
She will still have to go back for a check-up once a year.
It's people like Sisenstein who state Senator Cleave Simpson, R - Alamosa, wants to help.
“Part of my rural district have lost population in the last decade,” said Simpson. “Part of that then drives access to doctors, that direct supervision out, and makes life complicated for my constituencies and my physician assistants providing quality, affordable healthcare to them.”
According to the Colorado Department of Public Health and Environment (CDPHE), there are currently no physicians or PAs practicing in Cheyenne, Costilla, Crowley, Jackson, Mineral and San Juan counties. There's not a single PA in Bent, Custer and Phillips counties, and no physicians in Hinsdale, Kiowa and Washington counties.
Simpson and state Senator Faith Winter, D - Westminster, are co-sponsoring Senate Bill 23-083, which, if passed, would allow physician assistants to do more.
“This is about allowing physicians assistants to provide care they’ve been trained to do through collaborative agreements that make sense in our current health care setting,” said Winter.
Right now, PAs can prescribe medications, including controlled substances, and diagnose and manage conditions, but they must be under the supervision of a physician. SB 23-083 would allow them to eventually practice without that supervision.
“This bill requires 3,000 hours of supervised training. And if they’re changing what their practice is, if they’re learning an additional skill, it’s an additional 3,000 hours,” said Winter.
This is not the first time a bill of this nature has been introduced in the Colorado legislature. The topic was first introduced in 2021, then again in 2022.
“We’re making it explicitly clear this year that they cannot be majority owner in any practice, which means they cannot run their own practice without a physician,” said Winter.
Lawmakers hope third time's the charm.
“We’re really trying to improve access to all Coloradans,” said Denver-based physician assistant Ron Rasis.
The American Academy of Physician Associates says 17 states and the District of Columbia allow physician assistants to practice under collaboration rather than supervision. North Dakota, Utah and Wyoming do not require that collaborative agreement.
But not everyone is onboard with the legislation.
“I’m an ER nurse myself. I work with PAs on a daily basis, and I truly appreciate the work they do,” said state Senator Kyle Mullica, D - Northglenn. “When you look at physician assistants, that’s in their title. They’re a physician assistant, and they go to school to be generalists. They don’t go to school for specialties.”
That lack of specialty concerns Mullica, especially when it comes to patient safety.
“Collaboration is not oversight,” said Mullica. “What I’m interested in seeing is that oversight to make sure there is a backstop to make sure that we have that level of expertise when it comes to caring for our patients."
Mullica says he feels for patients who have to travel long distances for care, but thinks there are other ways to address the issue.
“I think that we need to have that conversation. Do we incorporate more telehealth for that oversight? Do we incorporate that maybe a PA doesn’t have to work under just one physician, they can work under a number of physicians and have those relationships?” he said.
Groups like the Colorado Medical Society (CMS) and the Colorado chapter of the American College of Emergency Physicians (ACEP) both stressed the importance of physician-led care teams.
In a statement, Dr. Patrick Pevoto, CMS president, said, “Every day we see the benefits of those teams with our patients, including our valued work of physician assistants. While we have not seen language on a bill for 2023 and therefore don’t have a position, our hope is that together we can address the Colorado Association of Physician Assistants concerns.”
The Colorado ACEP said in a statement, “Teams led by board-certified emergency physicians are preferred by patients because they consistently deliver higher-quality, less costly care. Physician assistants are an integral part of physician-led teams, and we support simplifying the administrative requirements for oversight of PAs by physicians in Colorado.”
Sisenstein hopes this is the year for change so she can take that four-hour roundtrip journey off her already busy to-do list.
“It’s extremely frustrating to have to spend that expense to get healthcare. I would not call that affordable healthcare that’s for sure,” she said.
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