Physicians are sounding the alarm about a Wisconsin bill that would confuse patients by replacing the longstanding and well-known title of “physician assistant” with the term “physician associate.”
Senate Bill 435 also would allow physician assistants (PAs) to practice without any physician involvement. While physician assistants are valuable members of the physician-led health care team, they are not a replacement for physicians.
The AMA and other physician organizations strongly opposes both provisions, which threaten the safety of patients and will lead to patient confusion. Equally important, this is not what patients want. According to an AMA survey, 95% of U.S. voters agree that physicians should be involved in their medical diagnoses and treatment decisions.
That is why the AMA is fighting scope creep, defending the practice of medicine against scope of practice expansions that threaten patient safety and undermine physician-led, team-based care.
“The AMA has long valued the commitment of physician assistants to the team-based model of care and greatly respects the contributions physician assistants make to the health care team,” says an October letter from the AMA (PDF) to Wisconsin Senate Health Committee Chair Rachael Cabral-Guevara. “However, physician assistants do not have the same skillset as physicians and are not a replacement for a physician. Yet, SB 435 eliminates physicians from the care team altogether after physician assistants complete just 7,680 hours of clinical practice, which can include any clinical practice hours completed during a physician assistant’s educational program.”
The bill would set “Wisconsin apart from most of the country, including the 45 states that currently require physician supervision or collaboration of physician assistants, and one state that requires a practice agreement,” says the letter from AMA CEO and Executive Vice President John Whyte, MD, MPH. “Only a handful of states have a time-limited collaboration requirement as proposed in SB 435. The overwhelming trend by state legislatures across the country has been to defeat legislation like SB 435. In fact, more than a dozen states defeated similar proposals this year.”
With health care growing increasingly complex, “a fully coordinated, quality-focused and patient-centered health care team is the optimal means by which Americans receive their health care,” Dr. Whyte note. “In the physician-led team approach, each member of the team plays a critical role in delivering efficient, accurate and cost-effective care to patients.”
Physician assistants, he noted, “are uniquely educated to provide care as part of a physician-led team, but not without physician involvement.”
While doctors complete more than 12,000 hours of clinical education and training during their four years of medical school and three-to-seven years of residency training, “the current physician-assistant education model is two years in length with 2,000 hours of clinical care—and it includes no residency requirement,” Dr. Whyte wrote.
In its testimony from President Elect Michael White, MD, the Wisconsin Medical Society pointed out the fallacy of the argument that the legislation is necessary to allow physician assistants—as they repeatedly state—“to practice to the full extent of their license.”
“Existing regulations allow PAs to practice to the fullest extent of their training and competencies while maintaining appropriate physician oversight,” Dr. White said in his testimony. “This balanced approach maximizes PA contributions to health care teams without compromising patient safety. There is no evidence that current collaborative requirements limit PA effectiveness or workforce deployment.”
In November, the bill passed out of Senate Health Committee by a 3–2 vote. The Wisconsin Medical Society opposes the bill and included Dr. Whyte’s letter along with its testimony packet provided to the Senate Health Committee. Six other physician specialty associations also have weighed in with their opposition. A spokesperson for Gov. Tommy Evers said the governor also opposes the bill.
PA term change is “wholly unnecessary”
In addition to allowing PAs to practice without any physician involvement, SB 435 would also change what that “PA” stands for, shifting from “physician assistant” to “physician associate.”
That title change “contradicts the well-known health care lexicon, will lead to patient confusion and result in increased costs to the state,” Dr. Whyte wrote. “This title change is wholly unnecessary. It does not improve the cost or quality of health care for patients in Wisconsin, nor does it improve access to health care. Rather, it replaces a term that has been common in the health care lexicon for decades with a term that is incompatible with the existing health care infrastructure and will increase patient confusion.”
The “physician assistant” term prevails in health care, is “widely used by the physician assistant profession and is commonly understood by patients. Changing an established health care professional’s title, especially one that has been around for decades, will undoubtedly lead to patient confusion,” says the AMA’s letter.
In addition, “the term ‘physician assistant’ is used throughout federal statutes and regulations, as well as the laws and regulations of 47 states and the District of Columbia.” Hospitals, health systems, payers and physician practices all widely use the term “physician assistant” in their public communications and embed it in their policies, procedures and bylaws.
Meanwhile, the only certifying organization for physician assistants—the National Commission on Certification of Physician Assistants—uses the traditional term. One other point of confusion is that “physician associate” is the term that is frequently used by physicians to refer specifically to their physician colleagues.
That is not to mention that several states have a separate license for the “associate physician,” intended for professionals who graduated medical school but have not yet matched into a postgraduate training or residency program. Making the change also would “be time-consuming and expensive—an expense that will likely be pushed onto businesses and health care entities across the state, including state-funded entities, with no benefit to the patient or quality of patient care,” Dr. Whyte wrote.
Learn more with the AMA about the differences that set apart physicians and physician assistants.
Other reasons to reject the bill
The AMA’s letter also raises other key points in opposition to SB 435, detailing how:
- Expanding physician assistant scope of practice will not increase access to primary care.
- Multiple studies have shown that physician assistants and other nonphysicians order more diagnostic imaging in the emergency department compared to physicians.
- Other studies have found that physician assistants tend to prescribe opioids more frequently compared to physicians.
Visit AMA Advocacy in Action to find out what’s at stake in fighting scope creep and other advocacy priorities the AMA is actively working on.
