February 27, 2024

Letter to the Editor: PA bill would increase access to medical care and require collaboration

The article “look closely at physician assistant bill” published in the Newton Daily News March 24, 2023 contains several misstatements that deserve a closer look. To help meet ever-increasing challenge of keeping medical care in our small towns and medically underserved urban areas the PA bill, HF 424, updates 50-year-old PA law making PA regulations more flexible and less costly. This is especially timely as Buffalo Center’s (pop. 905) only medical clinic closed March 24, 2023. And the only medical clinics in Gladbrook (pop. 945) and Allison (pop. 1029) are scheduled to close soon. Each of these clinics was staffed successfully by PAs or, more recently, by nurse practitioners (NPs). PAs and NPs have similar skills so are frequently utilized interchangeably just as MDs and DOs are.

Since PA salaries are often one-third of physicians’, small-town medical clinics have been able to keep going. And physician costs are minimal as they are not required to provide direct oversight, only to communicate periodically as needed.

The legislation requires collaboration instead of state-mandated supervision leaving oversight to the employing clinic or hospital, and the PA state board (that has physician members). This method has been shown to be safe and effective for nurse practitioners in Iowa and 25 other states, and for PAs in 8 states where supervision was suspended for 3 years during the COVID pandemic and 3 additional states (ND, WY, and UT) where it was removed legislatively. And collaboration is defined in HF 424. Also the bill decreases physician liability by making the PA responsible for the medical care they provide instead of the physician just as NPs, nurse anesthetists and optometrists are responsible the care they render.

Regarding quality of PA medical care and outcomes many studies have shown it to be similar to physician care. Regarding years of education family physicians have less than one-third of the 3 years of training of pediatric physicians in pediatrics yet successfully treat many medical conditions in children. The same is true for Gynecology and other medical specialties. Like one of my mentors said, “you don’t have to be a brain surgeon to do a good job of taking care of strep throat”.

As a PA I have staffed Redfield’s (pop. 835) only medical clinic as its sole medical care provider for the past 36 years. After serving as a Green Beret combat medic in Vietnam I graduated from the University of Iowa College of Medicine PA Program in 1977 where we took about half of our training in the same classes as the medical students. Since Dr. Edwards, who is quoted in the article, graduated from the University of Iowa medical school in 1984 he would have taken classes with the PA students. Understanding the shortage of medical care providers, both the University of Iowa College of Medicine and Warren Gall, MD, chair of the Iowa medical board, support the PA bill. It passed the Iowa House on a 90-8 vote on March 7, 2023.

Ed Friedmann, PA