Physician Assistants

MD hospitals face shortage of health professionals

Anne Zieger — Thu, 28 Aug 2008 11:33:46 -0400

Like their peers across the country, Maryland hospitals are continuing to struggle with a shortage of health professionals, according to a study released this week by the Maryland Hospital Association. Vacancies for physician assistants, occupational therapists, speech therapists and respiratory therapists shot above 15 percent in 2007, the Association found. Meanwhile, vacancy rates for respiratory therapists showed the greatest increase, at almost 20 percent. That's up six points in just one year.

From 2006 to 2007, vacancy rates for nurses actually declined, a surprising finding given the usual state of the nursing market. Vacancy rates in 2007 fell to 10 percent, down from 13 percent in 2006 and a high of 15.6 percent in 2001. Still, Maryland hospitals need an additional 2,603 nurses to meet the state's growing demand, and vacancy rates were well above the national average of 8 percent in 2007.

To learn more about the shortages:
- read this Baltimore Business Journal piece

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Trend: Dermatologists give cosmetic patients red carpet treatment

Anne Zieger — Tue, 29 Jul 2008 10:33:18 -0400

Increasingly, dermatologists are offering a broad range of cosmetic services to patients--several million a year, according to estimates by the American Society for Dermatologic Surgery. This is no surprise, given that a Botox shot to the forehead can offer $500 per 10 minute treatment, while insurers may pay only $60 to $90 for a visit that includes a 10-minute full-body check for skin cancer.

While no one is suggesting that offering beauty treatments is inherently a bad thing, some observers have started to question the way dermatologists juggle care for beauty treatment customers and traditional dermatological patients. Often, dermatologists offer luxury treatment to their beauty patients while offering bare-bones service to those who need traditional dermatology care like treatments for acne and psoriasis.

For example, many dermatologists offering beauty treatment offer a special dedicated telephone line for such customers, while calls for standard dermatology care go to voice mail. In some cases, doctors have hired a special receptionist--dubbed a cosmetic concierge--to attend to their beauty-treatment patients. This gives patients with traditional skin-care needs the message that their care is less important, some doctors suggest.

Worse, the increasing emphasis on beauty treatment may impact patients' health. A study published last year in The Journal of the American Academy of Dermatology found that dermatologists in 11 American cities and one county offered faster appointments to a patient calling about Botox than someone calling about a changing mole, which could be a sign of skin cancer.

Meanwhile, some dermatologists are so eager to focus on beauty treatments that they're handing off many of their medical dermatology patients to nurse practitioners and physician assistants, another practice that worries observers. However, this may be partly because demand for medical dermatology services is greater than the supply.

To learn more about this trend:
- read this article from The New York Times

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States may give advanced-practice nurses wider scope

Mon, 14 Apr 2008 06:59:58 -0400

A wave of bills are working their way through state legislatures that would expand the scope of practice for advanced-practice nurses. In fact, at least 24 states are either considering such bills or expecting to see such measures filed this year, according to political researchers. The bills address a broad range of issues, including independent practice, doctor supervision, prescribing authority, or extended prescribing to include controlled substances. Many of these measures are opposed by the AMA and its state affiliates, who say they have safety concerns. But observers say such legislation likely will have some momentum, given the growing physician shortage and a growth in advanced degree programs for nurses.

These bills follow the establishment of a similar law in Pennsylvania, which expanded the scope of practice for nurse practitioners, clinical nurse specialists, nurse midwives, physician assistants and dental hygienists. The new law, which was enacted in 2007, gave nurse practitioners the right to order medical equipment and refer to physical therapists and related practitioners. It also gave nurse midwives prescribing privileges that include permission to prescribe controlled substances.

To learn more about this trend:
- read this AMNews piece

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Physician assistant, nurse practitioners roles blurring

Fri, 14 Mar 2008 07:59:54 -0400

Despite the fact that the two have different types of training, in practical situations, nurse practitioners and physician assistants are increasingly being called upon to do similar work (particularly when the physician assistant has a master's degree). In many practices, the two are both conducting physical examinations, diagnosing illness and prescribing drugs. And in truth, the two take many of the same courses, though nurse practitioner training is focused on nursing, and PAs on the medical model. All of this is convenient for busy practices who need as much flexibility as possible in deploying their staff.

That being said, each have their own limitations. At least in Pennsylvania, nurse practitioners are supervised by doctors and available to respond to questions. However, PAs work directly for doctors and provide a limited scope of specified services. That's because their training differs meaningfully. To become an NP, one must have a bachelor's degree in nursing, then go on to get a master's in a subspecialty area. They also must get nationally-certified and state-licensed in their specialties, plus undergo periodic recertification--which includes the needs for continuing education credits. PAs, for their part, may not end up with a bachelor's degree, much less a masters, though such programs are available.

To learn more about this trend:
- read this Pittsburgh Post-Gazette piece

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