An overhaul of the regulations governing how physician assistants practice in Alaska has been in the works for several years, but the end result — which will go before the Alaska State Medical Board for approval on Nov. 17 — isn’t what most were expecting.
Physician assistants, hospital groups and health care associations agree that the regulations, if enacted as proposed, would severely limit how physician assistants can work in Alaska, with particularly harsh consequences for access to health care in rural Alaska. At a September meeting, more than 30 people testified against the regulations.
In an interview with The Alaska Current, Jenny Fayette, the board president of the Alaska Academy of Physician Assistants, said the proposed regulations surprised those who worked on the regulations for the past several years. She said they were supposed to update the profession and expand access, particularly in rural Alaska, not limit it.
“It’s going to restrict access to care for many Alaskans, especially Alaskans off the road system,” she said. “We’ve been the providers in these rural areas for a long time. We have regulations that are in place that definitely need to be modernized but not made more restrictive. It’s the opposite of what other states are doing, so for the Medical Board to propose these doesn’t make much sense, especially when we don’t have enough providers to go around right now.”
The Medical Board has not yet met to review or discuss the response to the proposed regulations, said Victoria Caltagirone, the spokesperson for the Department of Commerce, Community and Economic Development, or decided a plan forward. She said that’ll happen at the Nov. 17 meeting. If the board makes substantial changes to the plan, it would trigger a new round of public testimony.
Physician assistants can diagnose and treat patients with the supervision of a physician, which can be done remotely. They play a big role in delivering care in rural areas, where they are frequently the only health care provider and can be called on to provide care in a wide range of scenarios.
“It is well documented that Alaska’s healthcare system is severely challenged by workforce shortages, recruitment barriers and other limitations to access. Physician assistants play an important role on the front lines of our healthcare system, especially in rural Alaska, and are critical to ensuring access to timely and quality healthcare for Alaskans,” said Jared Kosin, the president of the Alaska Hospital and Healthcare Association, in a letter to the Medical Board opposing the regulations. “Our primary concern with the proposed regulations is the sheer disruption they could cause for access to healthcare services.”
Proposed regulations create barriers for workers
One of the major concerns raised by the changes is an enormous increase in the amount of time on the job a physician assistant needs before working in rural Alaska. It would go from 160 directly supervised hours to 2,400 hours, requiring about 14 months in an urban setting before working in rural Alaska. Fayette said the work requirement also doesn’t consider a person’s background or experience, creating barriers for even experienced health care workers, including her, from taking jobs in rural areas.
“If I decided tomorrow that I really wanted to go out and work in Naknek, I would need to leave my current job and go into another job for 14 months before I would even be eligible to go out there,” she said. “That just goes against our basic training.”
The other change would limit physician assistants’ scope of practice to their supervising doctor’s work. While physician assistants can have a broad range of training, under the proposed regulations, they’d be limited to only what their supervising doctor practices. That means if the physician assistant had training delivering babies, but their doctor didn’t, they’d have to step back even in emergencies.
“Now, these new regulations are trying to say that even if I’m experienced and worked delivering babies or taking care of babies, if my primary physician doesn’t also have that scope of practice, then now I can no longer do that,” she said. “That’s where it will make a huge difference for us in rural areas is that now our scope of practice is not tied to our experience and training, it’ll be tied to whoever is willing to collaborate with us in those areas. … That’s where access to care is going to really change.”
Changes would most affect Alaskans in rural communities
The changes also raise concerns that it’d worsen the existing disparities in Alaska’s health care system, with Alaska Native people feeling the brunt of it. In an editorial published in the Alaska Beacon, Shigone Beighle, a physician assistant who works in rural communities, says it’s clear the board is disconnected from and inexperienced with rural Alaska.
“By the mere action of allowing the proposed changes to get to this point in the process, it is very clear to me that the current Alaska State Medical Board is extremely disconnected from the critical health care needs of rural Alaska and the Alaska Native population. … As an Alaskan Native, this failure to consider these needs is glaringly obvious to me, as the regulations create further inequity, racial disparity and the marginalization of my people,” she wrote, later adding, “These proposed limitations increase the racial disparity that currently exists in Alaska to provide health care to the Alaska Native population. These proposed changes exemplify a shortcoming in the current structure of the Alaska State Medical Board with regard to the health care needs of the Alaska Native populations and the unique challenges of providing medical care in bush Alaska.”
Questions remain for the Medical Board
Fayette said it’s been difficult to answer why the regulations proposed by the Medical Board are so different from what had been discussed over the past several years. She said she hasn’t seen evidence that the current system is unsafe.
“If this were driven by unsafe practices of PAs, I’d get it,” she said. “But there’s no evidence to show that’s the case here. … I did a deep dive into see if we had PAs getting in trouble — how many suspended or surrendered licenses do we have — but there’s nothing to say, hey this is warranted, and we need to make this more restrictive.”
That’s something that Kosin with the Alaska Hospital and Healthcare Association echoed in his letter.
“Maintaining appropriate practice and training standards in the medical profession is crucial,” he said. “However, we have not heard of or received any widespread complaints about the quality of care provided by physician assistants in rural or urban settings, so to pursue such a drastic departure from the current standards is both surprising and alarming because it could be a deterrent for recruiting these professionals to Alaska.”
It’s left some wondering if there’s more going on here. Fayette said she’s trying to stay optimistic about the situation and hopes that it’s simply a result of people not being familiar with the work of physician assistants. She hopes the testimony at the last meeting, the written testimony and the continued outreach will make a difference and that the board will not move forward with the regulations at its Nov. 17 meeting.
“What I care most about is we continue to be able to serve the patients that we serve. I love my profession, I love doctors, and I love health care. I really, honestly feel that this is people not understanding the impact,” she said. “It’s not just word changes; it’s huge changes for our state.”
The Alaska Current reached out to the Alaska Native Tribal Health Consortium for comment but has not yet received a response at the time of publication.
Matt Acuña Buxton is a long-time political reporter who has written for the Fairbanks Daily News-Miner and The Midnight Sun political blog. He also authors the daily politics newsletter, The Alaska Memo, and can frequently be found live-tweeting public meetings on Twitter: @mattbuxton.
Matt Acuña Buxton is a long-time political reporter who has written for the Fairbanks Daily News-Miner and The Midnight Sun political blog. He also authors the daily politics newsletter, The Alaska Memo, and can frequently be found live-tweeting public meetings on Twitter.