BRIEF REPORT
Levels of supervision among practicing physician assistants James F. Cawley, MPH, PA-C, DHL (Hon); Elizabeth Bush, MBA
State laws mandate that 100% physician assistants (PAs) 90% be supervised by a licensed physician, but 80% the specific terms and 70% stipulations of supervi56% 55% 60% sion vary among state or 44% 50% federal statutes and regu37% lations. Because supervi40% 30% sion of PA practice by 30% physicians is a dynamic 20% process, task delegation patterns may evolve over 10% time as PAs gain more 0% experience working with 10 to 14 years 15 to 19 years 20 or more years 4 years or less 5 to 9 years physicians. This, in turn, Years of experience as a practicing PA may result in less physician time spent supervis- FIGURE 1. Percentage of PAs (N=5,636) who spend less than 10% of their time consulting with the physician ing the PA and the PA assuming greater degrees of responsibility in the perforPAs in active clinical practice, a response rate of 20.3%. mance of clinical activities. Medical sociologists have Results of the survey were compared with findings from other labeled this progression of clinical duties “negotiated national survey reports and sample surveys of practicing PAs, performance autonomy” and suggest that it is an ideal and were found to be quite similar, particularly in the areas descriptor of the PA-physician dyad in clinical practice.1 of demographic characteristics, practice setting, and specialty.3,4 For the purposes of this report: METHODS AND ASSUMPTIONS • Primary care includes family medicine without urgent This study examined the degree of physician supervision care, family medicine with urgent care, general pediatrics, reported by practicing PAs in various specialties. Data were and general internal medicine. drawn from the 2013 AAPA Annual Survey, a web-adminis• Consultation was defined as physician-PA interaction. tered national cross-sectional survey conducted by the Amer• Nonclinically practicing PAs, those primarily employed ican Academy of Physician Assistants.2 The survey was sent in nonclinical work such as education or administration, via e-mail link to 87,907 PAs assumed to be in active clinical were excluded. practice in September 2013; reminders were sent in subsequent The proportion of PAs who reported spending less than weeks. Responses to the survey resulted in a sample of 17,924 10% of time consulting was expected to increase over time. Respondents who had not changed their employer were asked to estimate the amount of clinical time spent James F. Cawley is a professor of prevention and community health and professor of physician assistant studies at George Washington University consulting with the physician. We plotted the percentage in Washington, D.C., and a senior research fellow at the American of PAs who spent less than 10% of their time consulting Academy of Physician Assistants in Alexandria, Va. Elizabeth Bush is with the physician with the length of time in clinical Senior Vice President of Member Value and Research at the American practice (Figure 1) over time in practice. Academy of Physician Assistants. The authors have disclosed no potential conflicts of interest, financial or otherwise. Richard W. Dehn, MPA, PA, DFAAPA, department editor DOI: 10.1097/01.JAA.0000458869.93806.0d Copyright © 2015 American Academy of Physician Assistants
JAAPA Journal of the American Academy of Physician Assistants
RESULTS The number of PAs who spent less than 10% of their time consulting with the physician based on their experience is www.JAAPA.com
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
61
BRIEF REPORT 100% 90%
Primary care
80% 70%
Internal medicin subspecialties
60% 50% 40%
Surgical subspecialties
30% 20%
Emergency medicine
10% 0%
4 years or less
5 to 9 years
10 to 14 years
15 to 19 years 20 or more years
Years of experience as a practicing PA
Other specialties
FIGURE 2. Percentage of PAs who spend less than 10% of their time consulting with the physician by specialty
shown in Figure 1. PAs with 15 or more years experience were more likely to report spending 10% of their time consulting with the physician compared with those with 0 to 14 years of experience (P
Levels of supervision among practicing physician assistants James F. Cawley, MPH, PA-C, DHL (Hon); Elizabeth Bush, MBA
State laws mandate that 100% physician assistants (PAs) 90% be supervised by a licensed physician, but 80% the specific terms and 70% stipulations of supervi56% 55% 60% sion vary among state or 44% 50% federal statutes and regu37% lations. Because supervi40% 30% sion of PA practice by 30% physicians is a dynamic 20% process, task delegation patterns may evolve over 10% time as PAs gain more 0% experience working with 10 to 14 years 15 to 19 years 20 or more years 4 years or less 5 to 9 years physicians. This, in turn, Years of experience as a practicing PA may result in less physician time spent supervis- FIGURE 1. Percentage of PAs (N=5,636) who spend less than 10% of their time consulting with the physician ing the PA and the PA assuming greater degrees of responsibility in the perforPAs in active clinical practice, a response rate of 20.3%. mance of clinical activities. Medical sociologists have Results of the survey were compared with findings from other labeled this progression of clinical duties “negotiated national survey reports and sample surveys of practicing PAs, performance autonomy” and suggest that it is an ideal and were found to be quite similar, particularly in the areas descriptor of the PA-physician dyad in clinical practice.1 of demographic characteristics, practice setting, and specialty.3,4 For the purposes of this report: METHODS AND ASSUMPTIONS • Primary care includes family medicine without urgent This study examined the degree of physician supervision care, family medicine with urgent care, general pediatrics, reported by practicing PAs in various specialties. Data were and general internal medicine. drawn from the 2013 AAPA Annual Survey, a web-adminis• Consultation was defined as physician-PA interaction. tered national cross-sectional survey conducted by the Amer• Nonclinically practicing PAs, those primarily employed ican Academy of Physician Assistants.2 The survey was sent in nonclinical work such as education or administration, via e-mail link to 87,907 PAs assumed to be in active clinical were excluded. practice in September 2013; reminders were sent in subsequent The proportion of PAs who reported spending less than weeks. Responses to the survey resulted in a sample of 17,924 10% of time consulting was expected to increase over time. Respondents who had not changed their employer were asked to estimate the amount of clinical time spent James F. Cawley is a professor of prevention and community health and professor of physician assistant studies at George Washington University consulting with the physician. We plotted the percentage in Washington, D.C., and a senior research fellow at the American of PAs who spent less than 10% of their time consulting Academy of Physician Assistants in Alexandria, Va. Elizabeth Bush is with the physician with the length of time in clinical Senior Vice President of Member Value and Research at the American practice (Figure 1) over time in practice. Academy of Physician Assistants. The authors have disclosed no potential conflicts of interest, financial or otherwise. Richard W. Dehn, MPA, PA, DFAAPA, department editor DOI: 10.1097/01.JAA.0000458869.93806.0d Copyright © 2015 American Academy of Physician Assistants
JAAPA Journal of the American Academy of Physician Assistants
RESULTS The number of PAs who spent less than 10% of their time consulting with the physician based on their experience is www.JAAPA.com
Copyright © 2015 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
61
BRIEF REPORT 100% 90%
Primary care
80% 70%
Internal medicin subspecialties
60% 50% 40%
Surgical subspecialties
30% 20%
Emergency medicine
10% 0%
4 years or less
5 to 9 years
10 to 14 years
15 to 19 years 20 or more years
Years of experience as a practicing PA
Other specialties
FIGURE 2. Percentage of PAs who spend less than 10% of their time consulting with the physician by specialty
shown in Figure 1. PAs with 15 or more years experience were more likely to report spending 10% of their time consulting with the physician compared with those with 0 to 14 years of experience (P
