By MELANIE KILGORE-HILL

In Arkansas, more than 700 physician assistants practice in every specialty and setting, filling the growing gap between physician supply and patient demand. “We appreciate PAs, and we like the concept,” said David Wroten, executive vice president of the Arkansas Medical Society. “They’re well trained as mid-level practitioners, and their ability to act as an extension of the physician can greatly impact the physicians’ ability to take care of a large number of patients.”

A Growing Need

Arkansas’s two Physician Assistant programs - University of Arkansas for Medical Sciences and Harding University - graduate approximately 80 PAs each year. Established in 1967, the profession currently has more than 168,300 practitioners in the US, engaging in more than 500 million patient encounters each year. In order to practice, a PA must have a Board approved supervising physician and delegation agreement in place prior to implementing treatment. A PA is not able to be issued a license without both an approved supervising physician and delegation agreement in place.

Finding Their Place

Ada Sochanska, PA-C, president of the Arkansas Academy of Physician Assistants, said the role of a PA still remains “more unfamiliar than new” in some areas. “While physicians and nurses know what PAs do, it’s not uncommon to encounter barriers in hospitals, typically related to credentialing or confusion as to who we report to,” Sochanska said, adding that many hospitals have never hired a PA before. ARAPA works with the state’s PAs to help them navigate the system and encourages questions and partnerships from Arkansas’s greater medical community.

Delivering Team Care

While a minority of mid-level providers have sparked a push for independence, Wroten said the majority of PAs he speaks with prefer being part of a team. “The AMS has been very supportive of PAs, including helping them pass licensing legislation,” he said. “Most are not interested in being independent, because they’re trained as assistants and respect the extensive training physicians have received. They recognize that medicine needs to be delivered via team care with a physician as head.” Wroten said ongoing evolution of the role of nurse practitioners, recently granted more independence in Arkansas, helped demonstrate the reality of provider shortages in rural areas - a common argument used in favor of mid-level provider autonomy. “Originally, there was an idea that if you give nurse practitioners full independence, they’d flood rural areas and solve the access problem,” Wroten said. “States that have done that have found that nurse practitioners still want to practice in the same areas with physicians, because mid-level practitioners by nature of their training want a support group, and the majority want to work in a physician’s clinic rather than independently.”

Act 303

Increased patient demand also is triggering notable changes to the future of PAs in Arkansas. In March, State Bill 112 (now Act 303) was introduced to authorize physician assistants be identified as a treating provider for insurance billing and claims and, if authorized by the supervising physician, allowed to file claims as the billing provider for medical services delivered by the physician assistant. Despite the victory for PAs, Wroten cautioned that Act 303 also carries implications that could negatively affect reimbursement. “Most insurance carriers pay 100 percent of reimbursement when services are billed under a physician, and often up to 20 percent less for a mid-level provider,” he said, citing the value of physician supervision as a key factor for payers. “If the PA is listed as both billing and treating provider, the doctor’s office could lose that amount.” Wroten also added that the physician is still fully responsible for care provided by mid-level providers, regardless of whose signature is on the form.

Better Care for Arkansans

Sochanska, who specializes in infectious diseases and was recently named director of Patient Safety at Baptist Health, said all efforts being taken at state level are designed to improve healthcare for Arkansans. “At the end of the day, we want to do what’s best for the people here at home,” she said. To that end, she and other leaders at ARAPA are working with the state’s healthcare community to educate and collaborate with other PAs. In March, the group hosted its first in-person conference since 2019. The event was well attended and feedback has been overwhelmingly positive. Lecture topics ranged from Polypharmacy, HIV and pain management to lifestyle medicine, pre- and post-phylaxis and breast disease. “We look forward to continuing these events and watching the bonds and networks grow stronger in the community,” she said.