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Students learning to be physician assistants, such as these at the Harding University Physician Assistant Program in Searcy, Ark., have courses more akin to the medical school model than to the nursing school model.

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

In Arkansas, odds are, there would not be.

Physician assistants (PAs) have had a presence in Arkansas for more than 35 years, but the state still lags far behind almost every other state in the nation in numbers of PAs employed. Projections by the American Academy of Physician Assistants in 2007 estimated that by this year Arkansas would have 121 PAs working in healthcare facilities. Only Mississippi has fewer. In contrast, PAs have a substantially greater presence in Arkansas’ other bordering states: 468 in Louisiana, 557 in Missouri, 885 in Tennessee, 965 in Oklahoma, and 4,259 in Texas. New York leads the nation with 7,359 PAs in 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. Typically, they conduct physical exams, diagnose and treat illnesses, order and interpret tests, counsel on preventive healthcare, assist in surgery, and write prescriptions.

The position of PA emerged from the Vietnam War era, when there was a severe physician shortage. Phil Tobin, vice president of the Arkansas Academy of Physician Assistants (ARAPA) explained that around that time, a great number of military medics with extensive experience were returning from Vietnam. “They were highly skilled and trained, more trained than nurses, 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. Today, most are Master’s level programs.

Kim McCord was in that first generation of licensed PAs, an Indiana native trained at the country’s first four-year PA degree program at Alderson-Broaddus College in West Virginia. To the best of her knowledge, she was the first PA in Arkansas and is the one who has been in practice here the longest. She’s been working as a PA in Camden since August 1972. She now works with the physicians of Ouachita Family Clinic, a satellite facility of Baptist Health System, but most closely with her supervising physician, Dr. Larry Braden.

A PA always has a supervising physician, the physician for whom the PA strives to be an extra set of eyes and hands. That supervision does not have to be on-site but can be by telephone. In Arkansas, the doctor has to be within one-hour commute to the clinic, though Tobin said many other states have more relaxed regulations on this point. 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 and take some of that load off so that you can spend time with your family. That’s the greatest advantage.”

Braden said his professional relationship with McCord is just about ideal. The two have worked together for 25 years. “In that time, Kim has grown in practice with me in mind, so in my absence I know that she treats my patients the way I would. We go over and establish protocols together and she works by those protocols. We’ve become very, very close.”

In rural areas like Camden, he said, PAs can be invaluable for addressing the high patient load.

Naturally, PAs do not make as much as physicians, but they do bring in revenue. Tobin said that through ARAPA’s recent efforts, Arkansas Blue Cross and Blue Shield has agreed to reimburse PAs at 100 percent of the physician rate. Other plans reimburse less, typically around 75 to 85 percent.

A common concern about using PAs is the argument than no one can do it as well as a physician can, Braden said. “But I think for the purpose that a PA is trained, they do it at least as well as a physician does.”

That resistance is more common from doctors than from his patients, he said. Only once every two or three weeks does a patient insist on seeing him rather than McCord. “It’s more often the reverse,” he laughed. “A whole lot of them insist on seeing her. They love her.”

A more substantive holdback doctors have about using PAs is whether they want to be legally responsible and maintain the liability for the work of a mid-level practitioner. “That is a very real concern that very quickly goes away when you work with someone like Kim,” Braden said. “I’m very confident that she will call on me if she gets stuck.”

Tobin said orthopedic surgeons seem to be the big champions of PAs in Arkansas. “Many of them have one or two PAs. One PA can be in the clinic seeing the referrals and one can be in the OR assisting,” he said. “The PA is working for you, so you’re getting the first assistant fee from the PA, plus you develop a close working relationship with each other, so they know how you like to work.”
A likely reason Arkansas has comparatively few PAs than other states is that the regulations here are more restrictive than a lot of places, Tobin said, though they are much more accommodating than when McCord began practice. Until 1999, Arkansas PAs did not have prescribing privileges.

To get licensed to practice in the state, a PA must apply in person to the Arkansas Medical Board in Little Rock with their proposed supervising physician present. Other states, such as Texas, just require the PA to mail in a physician-signed affidavit. Tobin said ARAPA is hoping to work with the Medical Board to change the current requirement.

Moreover, until 2005 there was no PA school in Arkansas. “We tried to get support for one years ago,” McCord recalled, “but there were just too many political and organizational challenges then. There was a lot more resistance to the idea of PAs then, a lot more misconceptions about what we were.”

Although there is still no state PA program, Harding University, a private college in Searcy established one in 2005. Tobin is also assistant clinical director for the program, which just graduated its first class students in July.
Of the 16 graduates, all have jobs and 11 remained in Arkansas. “It’s a competitive program,” Tobin said. “For our next class, we had 300 applications and will interview about 130 applicants for the 32 spots.” 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 assistant is 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.”

One job hazard is the regular question PAs receive: when are you going to go to medical school and finish your degree? “We continually have to explain to people that PA is the job, it is the degree,” McCord said. “It’s a very dependent practice. I am here to help the physician. I know who I am, what I can do and I know my limitations. I don’t mind. That’s just part of being a PA.”



March 2008

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