Scope of Practice and Autonomy of Physician Assistants in Rural Versus Urban Emergency Departments

Abstract

Objectives: This was a study of the scope of practice and autonomy of emergency medicine (EM) physician assistants (PAs) practicing in rural versus urban emergency departments (EDs).Methods: Using the American Academy of Physician Assistants (AAPA) Masterfile, a random sample of 200 U.S. EM PAs were surveyed, with oversampling of an additional 200 rural PAs. Location was classified by zip code-based rural-urban commuting area codes, and responses were compared about conditions managed, procedures performed, and physician supervision between rural versus urban groups.Results: A total of 237 responses were received from PAs in 44 U.S. states, of which (201) were valid responses (105 rural, 96 urban) from PAs currently practicing in EDs (59.3% exclusion-adjusted response rate). Compared to urban PAs, rural PAs more frequently managed cardiac arrest (67% vs. 44%), stroke (86% vs. 72%), multisystem trauma (83% vs. 70%), active labor (44% vs. 23%), and critically ill children (82% vs. 65%) in the past year. They were more likely to have performed intubation (65% vs. 44%), needle thoracostomy (21% vs. 8%), and tube thoracostomy (46% vs. 26%). Rural PAs more often reported never having a physician present in the ED (38% vs. 0%) and less often reported always having a physician present (50% vs. 98%). Rural PAs were also less likely to report that a physician evaluates more than 75% of their patients (8% vs. 18%) and more likely that a physician never evaluates all of their patients (19% vs. 7%).Conclusions: Rural PAs reported a broader scope of practice, more autonomy, and less access to physician supervision than urban PAs.ACADEMIC EMERGENCY MEDICINE 2014;21:520-525

Solo emergency care by a physician assistant versus an ambulance nurse: a cross-sectional document study

“…The literature describes that the PA is increasingly involved in primary care teams [ 5 , 6 ] and at the emergency department (ED) [ 7 ]. However, we found no information on the role and function of the PA in ambulance EMS.…”

Cross-over study of novice intubators performing endotracheal intubation in an upright versus supine position

“…Outside of the hospital, paramedics often use endotracheal intubation to care for unstable and critically ill patients. In addition, advanced practice providers such as physician assistants (PAs), are increasingly performing this procedure, with one recent study reporting 44-65% of PAs working in the ED had performed an intubation within the last year [1].…”

Physician assistants in Australasian emergency departments

“…Larger EDs most often use PAs in fast track areas . PAs are used in rural EDs where they usually have a broader scope of practice, more autonomy and less access to physician supervision than their urban colleagues . The exact role can be quite varied but is dependant on the experience of the PA and the practice preferences of the supervising physician .…”

“…2,4 PAs are used in rural EDs where they usually have a broader scope of practice, more autonomy and less access to physician supervision than their urban colleagues. 5 The exact role can be quite varied but is dependant on the experience of the PA and the practice preferences of the supervising physician. 1 The usual tasks of a PA currently include history taking, physical examination, prescribing medications, ordering diagnostic tests, patient counselling, clinical reasoning and referrals.…”