Health Care and Environment

Physician assistants want OK to prescribe drugs: Bill would make Indiana last state to allow it

March 19, 2007

Indiana could see a wave of new physician assistants working here if lawmakers allow the medical technicians to prescribe medicine.

So say the proponents of House Bill 1241, now being debated in the Indiana Senate. They claim Indiana, as the only state yet to grant the prescribing prerogative, forces doctors to hire fewer physician assistants and so loses health care workers to other states.

That's a particularly important issue in rural and some urban areas, where doctors are scarce. Because Hoosier doctors can delegate to a physician assistant all duties except prescriptions, having more assistants could help overstretched doctors see more patients.

After years of lobbying, Indiana's physician assistants appear to have their best shot ever to win prescribing authority. The House of Representatives approved HB 1241 in February, 95-1. A Senate committee is set to vote on the bill in the next week.

But doctors are their main opponents. Many worry that if physician assistants could prescribe medicine, they would set up competing medical facilities, with only loose supervision from doctors. They're also concerned that quality and consistency of care would suffer.

"What we really did not want to see happen is see one physician overseeing 50 PAs all over the state," said Dr. Vidya Kora, president of the Indiana State Medical Association, a professional group for doctors.

Some physician assistants already work at the burgeoning number of quick-service medical facilities inside retail stores, such as MinuteClinic, which operates mainly in CVS drugstores. In Indiana, such clinics are staffed mainly by nurse practitioners, who already can prescribe medicine here.

Because physician assistants earn about half what even a family doctor does, such clinics could use physician assistants to undercut doctors with lower-priced care. In Indiana, the average physician assistant earns $62,150 a year.

And since in-store clinics tend to treat routine problems, doctors could be left with only the sickest patients.

But Dr. Daniel Walters, a family physician in Seymour, said most physician assistants want to work in a typical medical office. His two physician assistants help his office see more patients, even when he is away tending patients at a local hospital.

"We can do that best with physician assistants, who can see patients with minor illnesses while I can focus on patients with more complicated illnesses," Walters told a Senate committee on March 14.

Physician assistants typically receive more than two years of training. Like medical students, they undergo lectures and labs in basic medical sciences and then do clinical rotations in various medical fields.

Most physician assistants work in hospitals, examining, diagnosing and treating patients, which can include interpreting tests, assisting surgeons and prescribing medicine. The doctors they work for must review their work within 24 hours.

HB 1241 would require a doctor not to wander more than 30 miles away from their physician assistants (or 60 miles for certain rural clinics). It also would require doctors to write out which duties they are delegating to their physician assistants.

Supporters of HB 1241, such as Dr. John Lucich, director of the physician assistant program at Butler University, say more physicians would look to hire physician assistants if the doctors could delegate all duties to the assistants. Exactly how many more positions would open up, Lucich and others didn't try to guess.

They did point to a 1994 article in the New England Journal of Medicine, which found that fewer assistants tended to work in states with poor environments for practicing-particularly if the states did not allow them to prescribe medicine.

Indiana would have to double its number of physician assistants to catch up with the national average.

There are 680 physician assistants in Indiana, according to the Bureau of Labor Statistics, or one for every 9,200 state residents. Nationally, there is a physician assistant for every 4,600 residents.

Kora, president of the state medical association, said he does not foresee that kind of "drastic" increase in the number of physician assistants hired by doctors.

The medical association wants some caveats in HB 1241 that would make sure physician assistants are tied closely to doctors.

Kora wants to require doctors to be on site to supervise any physician assistant who is prescribing medicine. Second, he said, physician assistants must not be allowed to prescribe controlled substances, or narcotics, for any longer than seven days.

"We are in favor of physician assistants adding to the quality of health care and the availability and the access-without compromising the quality," he said.
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