PAs Finding Opportunities as Hospitals Adjust to New Rules on Residents' Hours

from November 15, 2002, issue of AAPA News


By Christopher Doscher

It’s been four months since AAPA News reported on the passage of new rules limiting the number of hours medical residents can work. Are PAs seeing an effect in their hospitals?


The short answer is yes. PAs interviewed for this story said they are already experiencing an increased role for the profession. “We know in our own hospital [the new rules have] changed the demographics of employment here,” said John McNab, a PA and clinical transplant coordinator for Hartford Hospital, Hartford, Connecticut. “Clearly, it has impacted [the hospital’s] ability to cover surgical areas around the clock. It has been a boon of sorts for midlevel practitioners.”


The rules, adopted in July by the Accreditation Council for Graduate Medical Education and endorsed by the American Medical Association, limit to 80 the number of hours a medical resident can work in a week. The rules also state that no resident may work more than 24 hours in a row, and that residents must be given at least 10 hours off between shifts. The new rules don’t take effect until July 2003, but hospitals are planning now to fill anticipated gaps in coverage left by the reduced resident hours.


The new rules present an opportunity for PAs, who likely will be relied on heavily to make up for the hours that would have been filled by residents.


“The situation presents PAs with a great opportunity to help physicians and patients,” said Nicole Gara, AAPA vice president, government and professional affairs. Gara’s department is preparing materials to assist hospitals considering hiring PAs. “We’re assembling information for hospitals that will include, among other things, soon-to-be-published Medicare guidance on billing by physician-PA teams. This is critical, because finances are obviously a major factor in hospital staffing decisions.”


At Hartford Hospital, PAs have been gradually taking on an increased role, and the new rules will speed up that trend, McNab said. “In our department, they’re hiring a new PA for evening shift to supplement the resident coverage. There are probably a half-dozen more positions open within the institution in various subspecialty areas.”


“Fifteen years ago, there were maybe six to ten PAs working here. Now, we’re at the point where we probably have a hundred.” Critical care units in the hospital are now staffed almost exclusively by PAs and other midlevel providers, McNab said.


Other hospitals are also seeing the signs of change. Administrators at Yale-New Haven Hospital are increasing the number of PA positions available, said Judy Nunes, a PA in Yale’s neurosurgery department. “We’ve had three PAs in our department and just hired a fourth,” Nunes said. “We’re petitioning for another six.”


Many of the openings involve evening or weekend shifts, which could make it difficult to attract experienced PAs. But McNab suggests new graduates could take advantage of the openings to get their foot in the door.


While some hospitals may be struggling with the prospect of coming up with the money to fund extra PA positions, Emory University School of Medicine in Georgia is working on a different solution: using enrollees in a postgraduate PA program to fill the slots.


Virginia Joslin, director of Emory’s PA program, is attempting to finalize plans for a “career master’s” program at Emory, which would include academic training for PAs and would also allow them to be involved in research efforts that look at the outcome of care. PAs in the program would be paid a stipend approximately equal to that paid to medical residents. The opportunity to get involved with patient research and academics could attract both experienced and newer PAs to the program.


With residents working fewer hours, PAs in the Emory program will have a greater opportunity to exercise their skills hands-on, Joslin said. “For a year, they’ll get extensive training, both clinically and in skills that will make them better educators,” she said. “We have places all over the city that are medically underserved. It is my hope that by putting PAs in there to utilize their skills, they’ll be able to provide service beyond patient care.” Plans for the program include involving PAs in research on patient populations so that care can be adjusted to meet the needs of the population.


The problem is more complex than finding staff to provide coverage, Joslin said. The 80 hours a week residents are allowed to work may seem like a lot of time when compared to the average person’s work week but in reality it is not, when time spent on academic components of training, on-call time, and time spent with patients are factored in, Joslin said. “[Hospitals] are going to have to do something,” she said. “If you hire PAs, it’s cheaper than hiring additional faculty.”


The effect of the new resident rules could go beyond simply having PAs “fill the gaps”; PAs will likely see the nature of their jobs change. “Over time, we’ll be taking on more of a teaching role with residents,” Nunes said. She also sees opportunities for PAs to take on increased roles in research projects and patient consultations. “They will be roles PAs haven’t had before, such as interacting with consultants and specialists,” Nunes said. “From a public awareness point of view, it puts us on the radar screens.”


Overall, PAs see the new rules as a positive development for the profession. “I think it will make a lot of opportunities available, but it puts a lot of pressure on the profession to keep up with the demands of critical care and other settings,” McNab said. “We need to make sure we maintain a high level of care.”

 

Last Revised: 7/15/03