COVID-19: We can’t bounce back with only physicians

For the last 10 months, everyone in health care has lived their lives as if they were trapped in a burning building without a fire escape. 

No matter how much water we throw on the fire or how many firefighters (health care providers in this instance) we send in, we cannot gain control of the flames. The catastrophic loss of life has been insurmountable, and we often haven’t had enough physicians to take care of everyone. 

This is not new for our health care system. For years prior to this pandemic, we had been experiencing a physician shortage that is expected to worsen over the coming years. The Association of Medical Colleges (AAMC) predicts that the U.S. could see a shortage between 54,000 and 139,000 physicians in both primary and specialty care by 2033. Although the total physician supply is expected to grow, it won’t be at a fast enough rate to outpace demand. 

This is where physician assistants (PAs) and advanced practice nurses (APRNs) come in. Many people don’t realize that PAs and APRNs have been around for over 50 years. Both professions trace their roots to another physician shortage. In the late 1960s, in the throes of the Vietnam War, the U.S. was in desperate need of physicians but it couldn’t get them trained fast enough to help during combat. The solution: PAs and APRNs, who are trained to practice medicine and advanced practice nursing, respectively, and help provide essential health care to those who need it most. 

For 50 years, a plethora of research has shown that PAs and APRNs are safe, reliable, high quality health care providers and essential members of the health care team. But too often critics claim that because they have not gone through physician training, they cannot provide exceptional medical and surgical care. In fact, they already do. A recent comprehensive review of PA and APRN outcomes from 2008 to 2018 found that PAs and APRNs had similar outcomes compared to physicians including hospital length of stay, readmission rates, quality and safety and patient and staff satisfaction. 

Now our investment in these underappreciated professions is paying off. As someone who has worked as a vascular surgery PA for the past 18 years, I have experienced many difficult things during my career, but nothing compares the catastrophic loss of life we’ve seen in the COVID-19 pandemic. I have had both the benefit and the burden of being on the frontlines, and I have seen how PAs and APRNs have risen to the challenge. 

Since last March I have sent countless physicians, PAs and APRNs to care for patients suffering from a disease that initially we knew little about. I asked new graduate physicians, PAs and APRNs to take care of the most critically ill patients in the intensive care unit (ICU), and they did. From providing direct patient care in emergency departments and ICUs, to conducting mass COVID-19 screening and testing to managing vulnerable nursing homes and homeless patient populations, PAs and APRNs were there.

To be clear, PAs and APRNs are not physicians, nor are they trying to be. But that doesn’t mean they shouldn’t be allowed to care for patients to the fullest extent of their education and training. PAs and APRNs don’t go through the many years of medical school and residency training that our physician colleagues go through — a training we appreciate and respect. But both professions require rigorous masters and/or doctorate level training, and many PAs and APRNs are highly acclaimed clinicians, professors and researchers. A 2018 policy proposal by The Hamilton Project noted that PAs and APRNs give similar care to that of physicians, at a lower cost.

Despite this, PAs and APRNs are often held back by local, state or federal laws and regulations put in place decades ago that haven’t quite caught up with the evolution of our health care delivery system. Despite research showing no significant variation in health outcomes by provider types, some groups continue to spread misinformation about PAs and APRNs in order to thwart efforts to modernize practice laws and expand access to care for patients. 

The pandemic broke through decades of impasse on this issue. We know that PAs and APRNs had the skills needed to take care of the overwhelming numbers of patients flooding the hospital systems.  Health care organizations, government officials and governors in some of those states hardest hit have issued executive orders to remove all outdated and unnecessary barriers to PA and APRN practice so these clinicians could do what they do best: provide patient care.  

It has worked. A recent article reported that a PA’s and APRN’s training, flexibility and adaptability has been crucial in caring for COVID-19 patients. Their unique skill set allowed them to be where we needed them most: at the patient’s bedside. Recently, the U.S. Department of Health and Human Services (HHS), U.S. Department of the Treasury (USDT) and U.S. Department of Labor (DOL) issued a jointly written report recommending that all states remove requirements for “rigid collaborative practice and supervision agreements” for PAs, APRNs and other health care practitioners when they are not necessary for patient safety.

If there is one lesson we’ve learned from this terrible pandemic, it’s that our health care system can’t survive without PAs and APRNs. They will be essential when rebuilding our nation’s health care system. Our laws and policies should allow them to continue to do so.

Jennifer M. Orozco PA-C, DFAAPA is an assistant professor and the director of Advanced Practice Providers at Rush University Medical Center in Chicago and a Public Voices Fellow. She is also the former president and legislative co-chairman for the Illinois Academy of PAs and director at large for the American Academy of PAs Board of Directors. The views expressed here are the author’s own.