When you go to an urgent care center or the emergency room for help, you might not actually be seen by a doctor. The person examining you is wearing a white coat or scrubs and a stethoscope, but could be a physician assistant. That's OK if you have a minor ailment; otherwise, it could cost you your life.
George Trovato, 39, went to an urgent care center in Wading River, New York, for joint pain. A PA told him to start an exercise routine and sent him home. Two weeks later, he was dead from a heart attack. His wife is suing, claiming he didn't know he wasn't being seen by a doctor and didn't get the diagnostic tests that might have saved his life.
Yet New York Gov. Kathy Hochul is pushing to allow PAs more freedom to practice without a doctor's supervision, worsening the danger that already exists. Right now, the law requires PAs to be supervised, though that can mean a review of patients' charts many hours after the fact. Supervision requirements went by the wayside during COVID-19. Hochul's proposal would codify letting PAs do almost everything a physician does, including diagnosing, without review.
After many tragedies, the UK's National Health Service (NHS) is doing precisely the opposite. On January 28, the NHS announced it will reduce the use of PAs and bar them from treating undiagnosed patients.
Overreliance on PAs has been a front-page tabloid issue in the UK ever since 30-year-old actress Emily Chesterton died from a blood clot in her leg that was missed by a PA during two visits. Chesterton thought she was being seen by a doctor. The PA incorrectly diagnosed her with a sprained calf and "long COVID-19," then sent her home. After she succumbed to a pulmonary embolism, the coroner concluded she should have been sent to a hospital emergency center.
Diagnosis is the danger point. Becoming a physician requires at least four years of medical school plus one or several years as a resident in training at a hospital. It's the years of study in biology, chemistry, and bodily systems that enable a doctor to diagnose the less common cause of a set of symptoms.
Syracuse University researchers show that "the truncated training period of PAs relative to physicians contributes to a higher average diagnostic error rate." They explain that "PAs typically compare favorably to physicians in terms of post-diagnostic care." But you need to be seen by a doctor to analyze your problem first.
It's a problem because a quarter of the time, American patients are now being seen by nonphysicians. They need to be informed of that and know when it's a danger.
PAs came on the scene in the 1960s in response to the beginning of a doctor shortage, which is ongoing. Large hospital systems and outpatient care centers began hiring them because they are cheaper. They cut the wait time to be seen, and many argued they would reduce overall costs to the healthcare system.
But now the evidence shows that using PAs comes with a cost. The Syracuse researchers warn of a "lower quality of diagnosis and treatment in the healthcare system."
There's no question the U.S. has a physician supply problem. The Association of American Medical Colleges estimates that the nation will be short 86,000 doctors by 2036. The causes are too few incentives to attract young people to the profession and too few residency programs funded by the government to accommodate medical school graduates.
Both of these problems are fixable. Becoming a doctor in the U.S. requires 11 to 19 years of graduate school and hospital training, and students graduate from medical school with $200,000 of debt, on average. That is being remedied.
New York University Grossman School of Medicine made history in 2018 by offering free tuition to all its admitted medical students, thanks to a $200 million bequest from Elaine and Kenneth Langone. Several other distinguished schools have followed, including Johns Hopkins University, Case Western Reserve University, and Albert Einstein College of Medicine. Anyone interested in donating to improve healthcare in the U.S. should consider supporting medical education. Increasing the supply of educated caregivers is far better than lowering standards.
Medicare funds the residency programs, and the number of slots can be increased by federal lawmakers. Congress foolishly downsized that number in the 1980s and '90s on the erroneous belief that more doctors would encourage unnecessary healthcare consumption. In fact, the doctor shortage has led to unwise remedies such as overreliance on PAs.
All over the country, governors and legislators are being pressured by the American Academy of Physician Associates, a lobbying group, to blur the distinctions between physicians and PAs. Hochul should realize that New York is one of the medical capitals of the nation. Lowering the standard of care will imperil that reputation and put New Yorkers' lives at risk.
Betsy McCaughey is a former Lt. Governor of New York State and Chairman & Founder of the Committee to Reduce Infection Deaths at www.hospitalinfection.org. Follow her on Twitter @Betsy_McCaughey.