309 Physician Assistant Scope of Practice 2015
Due to its generalized applicability, primary care has a positive effect on
health, cost, and quality.224 Patients that receive regular primary care services tend to be healthier, incur less cost, and suffer from fewer complica-
tions.225 Conversely, patients without access to primary care generally incur
higher healthcare costs and have poorer health outcomes.226 There is widespread agreement that a greater primary care capacity in the United States is
needed.227 The Patient Protection and Affordable Care Act (“ACA”) exposed the potential inability of America’s healthcare workforce to meet expected demands, particularly in primary care.228 Further, ACA’s Medicaid
coverage is predicted to increase the annual number of primary care visits
by as much as twenty-four million by 2019.229 Full and expanded utilization
of PAs and their skills is vital to meeting this shortage and expanding access to primary care.230 PAs are increasingly involved in specialty and subspecialty care, with the second largest percentage of PAs practicing in surgical subspecialties.231
mately 31% of PAs work in the primary care field. Id.
224. See generally Thomas Bodenheimer et al., Improving Primary Care for Patients
with Chronic Illness, 288 J. AM. MED. ASS’N 1909 (2002) (examining research evidence that
demonstrates that components of the chronic care model can improve quality of care and can
reduce the costs of obtaining that care).
225. See generally INST. OF MED., COMMITTEE PRIMARY CARE: AMERICA’S HEALTH IN A
NEW ERA 69 (Molla S. Donaldson et al. eds., Nat’l Acad. Press 1996); Starfield, supra note
222, at 478. The facts cited in the paper by Starfield demonstrate that having effective primary care systems in place in a health system results in improvements in health care access,
cost, and quality. Id. Michael Chernew et al., Would Having More Primary Care Doctors
Cut Health Spending Growth?, 28 HEALTH AFF., 1327, 1327-35 (2009); James Macinko et
al., Quantifying the Health Benefits of Primary Care Physicians Supply in the US, 37 INT’L J.
HEALTH SERVICES RES., 111, 111-26 (2007).
226. Stephen M. Petterson et al., Having a Usual Source of Care Reduces ED Visits, 79
AM. FAM. PHYSICIAN 94, 94 (2009). available at http://www.aafp.org/afp/2009/0115
227. T. Bodenheimer & H. Pham, Primary Care: Current Problems and Proposed Solutions, 29 HEALTH AFF. 799, 799-805 (2010).
228. U.S. DEP’T HEALTH & HUMAN SERVS., PROJECTING THE SUPPLY AND DEMAND FOR
PRIMARY CARE PRACTITIONERS THROUGH 2020 1 (2013), available at http://bhpr.hrsa.gov/
229. Adam N. Hofer et al., Expansion of coverage under the Patient Protection and Affordable Care Act and Primary Care Utilization, 89 MILBANK Q. 69, 69 (2011).
230. MINN. DEP’T OF HEALTH, HEALTH WORKFORCE SHORTAGE STUDY REPORT: REPORT
TO THE MINNESOTA LEGISLATURE 34 (2009), available at http://www.health.state.mn.us/
231. 2010 AAPA CENSUS, supra note 230, at 15; see also Am. Acad. Of Physician Assistants, Specialty Practice Issue Brief: Physician Assistants in Surgery 1 (2011), available at
http://www.aapa.org/WorkArea/DownloadAsset.aspx?id=651 (“Twenty-five percent
(19,000) of the nearly 75,000 clinically practicing PAs work in surgical specialties or sub-specialties.”).