At Yale, New Rules Create Jobs for PAs

from July 30, 2002, issue of AAPA News


By Hillel Kuttler

Anticipating the announcement of new rules by the Accreditation Council for Graduate Medical Education (ACGME) to restrict physician residents’ work weeks, Yale-New Haven Hospital began planning in March to fill in the lost hours. Its conclusion: hire additional physician assistants.


In support of the ACGME ruling, the American Medical Association at its annual meeting in June adopted a policy that outlines what organized medicine considers appropriate – and safe – working hours and conditions for resident physicians.


At Yale-New Haven, the department of medicine this year will increase the number of PAs it employs from two to six. Its department of surgery will jump from two to 12 PAs.


Other facilities are taking similar steps. New York Hospital Medical Center of Queens’ surgery department plans to add three or four PAs; nearby Long Island Jewish Hospital’s cardiothoracic department, at least one. Richard Murphy, senior PA at Tufts New England Medical Center’s department of surgery, hopes for an additional PA in surgery and two more in cardiac surgery.


“It makes things a lot tougher. As they cut back on residents and residents’ hours, we’re put in a bind here,” Murphy said of the effect of the ACGME ruling on the Boston hospital.


Chief of Staff Peter Herbert, M.D., said Yale-New Haven got a head start on addressing the shortfall, but he expected that competitors will catch up soon. He predicted that hospitals across the country will compete for PAs, with a resultant shortage of PAs.


No wonder, Herbert joked, that a colleague referred to ACGME’s edict as the PA Employment Act. The new rules will go into effect in July 2003 and will limit to 80 the number of hours that can be worked in a week by a physician resident. Residents also must work no more than 24 hours in a row and must receive 10 hours off between shifts. Residents are commonly made to work 100-120 hours weekly.


Why PAs? Why not? responded Herbert, whose daughter is a PA, as are his two sisters (one later became a physician). As chair of the Hospital of Saint Raphael’s (also in New Haven) department of medicine, he had employed 15 PAs, who served “much the same role as resident physicians,” he said.


With the hours of residents set to be cut by next summer, PAs at Yale also “will be assuming many of the roles residents served,” he added. “Institutions that have come to depend on them for care will look to them for midlevel care [now]. PAs already have a great record. They’re excellent communicators with both patients and attending physicians. They become very conversant in hospital operations. It’s generally recognized that they give superb care.


“Part of the challenge is integrating PAs into teams on teaching services, where PAs and physicians work elbow to elbow.”


Were additional PAs not hired, attending physicians would be left to fill the staffing void, Herbert said. Still, hiring additional PAs means making cuts elsewhere, increasing efficiency, and managing costs. Finding additional funds in the operating budgets may be hard to do for many “distressed hospitals,” Herbert acknowledged.


What hospitals lose in reduced residents’ hours, they make up in the long-term, anyway, because a PA might stay 20 years, while a resident moves on after three to five years, he noted. In either case, patient care will be unaffected, he said.


“They become very known, reliable quantities in the patient care equation,” Herbert said. “I don’t think there’s any question that PAs can assume the lion’s share of the responsibility that was shouldered by residents.


“If you think about the training of PAs and the needs of hospitals, they are the perfect fit for the needs in question. They receive an equivalent training to residents. Once they get specialization training, they’re off and running.”

 

Last Revised: 7/15/03