Economists typically believe that there is too much regulation in the medical field. Due to problems of asymetric information in determining doctor quality, economists believe there is a role for certification and licensure, but these requirements are currently too strict. For instance, many routine procedures could be preformed by a Nonphysician Clinician (NPC) such as a Physician Assitant (PA) or a Nurse Practioner (NP) at a lower cost with a small reduction in quality.
According to the American Academy of Physician Assistants (AAPA), there were 66,111 physician assistants practicing in the United states in 2005. Physician’s Assistants have varying levels of autonomy and prescription permission (see the DEA website) depending on the state legislation.
Below I will briefly outline the development of the position of the physician assistant. There is a more complete timeline located at the Physician Assistant History Center.
- 1964: Dr. Eugene Stead, Jr., disillusioned by organized nursing rejection of the nurse clinician program, decides that ex-military corpsmen with their previous training and experience would be suitable candidates for his two-year experimental program.
- 1966: Allied Health Professions Personnel Act (PL-751) promotes the development of programs to train new types of primary care providers.
- 1968: Health Manpower Act (PL-490) funds the training of a variety of health providers; American Association of Physician’s Assistants (AAPA) is incorporated
- 1970: Kaiser Permanente becomes first HMO to employ PA.
- 1972: National Board of Medical Examiners begins developing a certification examination for accredited PA educational program.
- 1976: Federal support of PA education continues under grants from Health Professions Assistance Act (PL94-484).
- 1977: Rural Health Clinic Services Act (PL95-210) provides Medicare reimbursement of PA and nurse practitioner (NP) services in rural clinics.
- 1986: Omnibus Budget Reconciliation Act PL 99-210 allows Medicare Part B to pay for PA services in hospitals and nursing homes
- 1987: Additional Medicare coverage of PA services in rural and underserved areas approved by Congress
- 1997: Balanced Budget Act of 1997– Congress increases PAs reimbursement rate to 85% of physician cost (previously 75% in hospitals, 65% for assisting at surgery, and 85% in nursing facilities)
- 2000: Mississippi is last state to enact legislation authorizing PAs to practice