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Mississippi Academy of Physician Assistants (MAPA) Board of Directors

In emergencies people rarely yell, “Is there a physician assistant in the house?”

In Mississippi, odds are, there would not be.

Physician assistants (PAs) have had a limited presence in the state for more than 20 years and have been licensed in the state for eight years, but Mississippi still lags far behind every other state in numbers of PAs employed. Mississippi consistently has the fewest PAs per capita, according to the American Academy of Physician Assistants (AAPA). A 2007 report by the AAPA projected that by January 2008, only 79 PAs would be in clinical practice in the state. Other estimates say there are between 100 and 120 PAs in the state.

Arkansas is Mississippi’s closest counterpart, with only a few more PAs in practice than Mississippi. Arkansas started its first PA school in 2005; Mississippi still has none.

In contrast, that same AAPA report shows PAs have a substantially greater presence in Mississippi’s other bordering states: 433 in Alabama, 468 in Louisiana, 885 in Tennessee and 4,090 in Florida. New York leads the nation with 7,359 PAs in clinical practice.

Physician assistants are healthcare professionals licensed to practice medicine with physician supervision. The profession is meant to be exactly what the name says: an assistant for physicians. PAs are most frequently found in primary care, but can work in any specialty and are particularly popular with surgical subspecialties. Typically, they conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive healthcare, assist in surgery, and write prescriptions.

Marla Moore, president of the Mississippi Academy of Physician Assistants (MAPA), said even though there were a scant few PAs in the state prior to 2000, when they were licensed and regulated by the state Medical Board, she said the past eight years have seen an increase in interest among physicians. “I get calls all the time from physicians that want a PA, but they want a PA tomorrow,” Moore said. “It’s kind of hard to do when we don’t have a program here or have the numbers that other states do.”

The position of PA emerged from the Vietnam War era, when there was a severe physician shortage. Around that time, a great number of military medics with extensive experience were returning from Vietnam, explained Phil Tobin, assistant clinical director of the new PA program at Harding University in Searcy, Ark. “They were highly skilled and trained, but there was no place in our medical area for them to fit in,” he said. “Duke University came up with this program to take medics and give them an extra level of training to create the position of physician assistant.”

Soon, other schools began PA programs and the profession took root.

A PA always has at least one supervising physician, the physician for whom the PA strives to be an extra set of eyes and hands. PAs are able to significantly extend the physician’s services and reduce the workload by seeing patients the physician would not otherwise be able to see.

“In the past, many doctors worked 16 hour days six or seven days a week,” Tobin said. “But new doctors or younger doctors seem to want a life and a family life on top of having a practice. I think a good way is to have a PA. It frees you up. You don’t have to stay late every night. Your PA can do rounds for you, take some of that load off so that you can spend time with your family. That’s the greatest advantage.”

Dr. Scott Stringer has worked with PAs his entire career, since his training in Texas and for 14 years at a Florida university hospital with a PA program on site. Now an otolaryngologist for University Medical Center at Jackson, Stringer supervises Moore and another PA. Having supervised 10 to 15 PAs in his career, he readily agrees that PAs are a great idea for physicians. In rural areas like Mississippi, he said, physician assistants can be invaluable for addressing the high patient load.

Stringer said he has had no problems with patients reluctant to be seen by a PA. “If someone’s coming in for something extremely complicated, of course they want to talk to their physician, but for the vast majority of visits, the PA can either take care of it or get almost all of it done by themselves while the doctor is seeing other patients,” he said. The physician can then concentrate on the advanced issues.

“We’ve hired two PAs, and would hire more if we could find them. They’re wonderful,” Stringer said. “We have terrible healthcare markers in this state and we need more providers. Mississippi is the lowest per capita of physicians in the country, so anything we can do to get more providers in, the better.”

Naturally, physician assistants do not make as much as physicians, but they do bring in revenue. Depending on the plan and the specialty, plans typically reimburse around 75 to 85 percent, though some reimburse 100 percent.

Some physicians express hesitation about assuming medical liability for someone who is not a physician, but Stringer said the issues are no different than hiring any other staff. “Under the regulations, they are closely supervised and monitored,” he said. “They stay within their scope of practice. It’s still ultimately my responsibility, but I don’t feel any greater risk supervising them than anyone else. I don’t think a lot of doctors realize these are Master’s level individuals who are trained very thoroughly.”

Moore said public education is a huge focus of MAPA and a common theme of being a PA in Mississippi.

Amy Ballard, a cardiothoracic surgery PA in Tupelo agreed. “Most people don’t know what PA stands for. A lot of people think you’re a Personal Assistant,” she said. “That’s not their fault; until you’ve worked with one, you just don’t know how valuable they can be to your practice.”

PA Krista Blanchard said that every single day she has to educate the physicians, administrators, nurses, staff and patients she encounters at Mississippi Baptist Hospital about her role, scope of practice and education. She said there’s a widespread misconception that PAs are people with general studies degrees who take a few classes and go into medicine.

Because physician assistants were created by doctors, for doctors, they are trained in the medical model. “We have to go through three or four months of gross anatomy and pharmacology, and we’re in class with the medical students and expected to take the same tests,” Blanchard explained. “They’re very hard on us. It’s not an easy program to complete or get into.”

Additionally, PAs have stringent CME requirements and must re-take their boards every six years. “I work in orthopedics, but when I go retake my boards, I’m tested on orthopedics and hematology and psychiatry and everything from A to Z,” Blanchard said.

Tobin said Harding University’s program, like others across the nation, is highly competitive. For instance, the program received 300 applications for the next academic year and will interview about 130 applicants for the 32 spots. He said students are a good mix of recent college graduates and non-traditional students, often who have many years of experience in ancillary health professions.

Physician assistants represent one of the fastest-growing professions. “Most polls usually have PA in the top 10 in satisfaction,” Tobin said. “We’re higher than nurses, higher than doctors. We have high job satisfaction and we get paid pretty well for our degree.”

Getting a PA program established within Mississippi is a long-term goal of the academy, Moore said. MAPA has begun talking with area universities about what it would take to get one started. “The main reason for the PA shortage here is the lack of a school. We’re going to get one here, but it may take a few years,” she said.

Ballard said Mississippi’s regulatory environment is actually very PA-friendly, with unrestricted Schedule II-V prescribing privileges and a strong relationship with the Medical Board. “They listen to us and actually ask for our input before they change any of our practice acts, and that just doesn’t happen in a lot of states,” she said. “I think we have just as much to offer as other states, and really our practice acts are so good. It’s a great state to practice in if you’re willing to be patient and educate people about what you can do.”

PHOTO CUTLINE: Mississippi Academy of Physician Assistants (MAPA) Board of Directors:
Jose Sosa, Director at Large;Tristen Harris, President Elect; Marla Moore, President; Amy Ballard, Immediate Past President; and Krista Blanchard, Secretary/Treasurer




April 2008

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