Introduction
Life is a constant of variable change and change is perhaps that the only real constant that exists.Laws are contrived based on a societies’ need to have acceptable parameters of which its members operate within. To that effect, this is how the law serves us.We find in that principle that laws must undergo constant scrutiny and change to assure that it has not become superannuated to societies needs as society changes. One such case is concerning healthcare laws, and societies demand, that health care laws change to respond to the needs of the people that it serves.
While these changes could encompass a vast array of healthcare topics, I’m going to focus on a specific code (law) for Physician Assistants (PA’s)in Texas that deserves a great deal of contemplation about its present purpose and efficacy.This code, titled as "Supervision Requirements," deserves scrutiny because it has created a hindrance that restricts PA’s from providing Texas residents with an explication to address the growing demands of accessible and affordable quality healthcare (Texas Medical Board. 2018).
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Background of Current Regulation
In 1993, with oversight from the Texas Medical Board, Texas enacted the Physician Assistant Licensing Act, which added a series of new requirements theTexas Occupational Code. In Section 204.204Supervision Requirements of the Occupational Code, stipulates that a PA in Texas must operate under the authority of a licensed physician or healthcare entity, of whom accepts total responsibility for the care of the patient by the PA, (Section 204.205). In 1965, when the first class of PA’s matriculated through Duke University, the goal then was to train medically advanced personnel to assist physicians in a growing crisis of a physician shortage (Advanced Solutions International, Inc. n.d.). That demand was never met, and over 50 years later, the US is still facing a physician shortage, much less Texas. So, the question remains, do laws such as Section 204.204 serve the public interest?
The Desired Change
Components in favor of the current law would argue that the entire idea and conception of the Physician Assistant profession is as in the name states “an assistant to the physician." Why does the current code need to be changed? Well, an intuitive proclamation points out the obvious problem, which the original intent of the PA profession of assisting physicians to keep up with the public health care needs, never worked. There has always been a provider shortage in healthcare. So now how do we resolve that issue? The answer is, PA’s need to have a career path that leads to independent practice that allows greater accessibility of health care providers by the public.A proposed way for this could be reflected in the new code. Such code simply is written out in this manner:
A physician assistant shall be supervised by a supervising physician or physicians.
After three years in practice, and under the training of a supervising physician or physicians, the PA will become eligible to apply for an advanced degree in medicine. Upon successful completion of an accredited 2-year course and testing, he/she can be awarded the title of “Doctor of Clinical Medicine”+ a designation of whatever they have specialized in during the previous three years before the advanced degree.
Upon being awarded the title of “Doctor of Clinical Medicine," the PA will be able to practice medicine independent and apart from a supervising physician and will be fully liable, civilly and criminally for medical malpractice.
(Advanced Solutions International, Inc. n.d.).
While this new proposal for a change in Texas Code isn’t exhaustive, it does serve as an example of “what could be” to address public healthcare crisis of physician shortages. It is an alternative to the current code that stagnates progression and currently has PA’s relying on their supervising physicians to practice medicine despite a public need. It also alleviates the medical liability of the physicians, to the PA upon completion of the advanced education degree. Lastly, medicine like laws are intended to benefit the public interest and so in considering the change any law, the public benefit must be the basis for such change. This is one law that would serve as that benefit.
References
Advanced Solutions International, Inc. (n.d.). Texas Academy of Physician Assistants Serving. Caring. Healing. Retrieved March 15, 2018, from https://www.tapa.org/AMSIMIS/TAPA/About_TAPA/About_TAPA.aspx
Texas Medical Board. (2018, March 15). Retrieved March 15, 2018, from http://www.tmb.state.tx.us/page/practice-acts
