New York bills aim to address medical shortage by increasing power of physician assistants

Two bills aim to increase New Yorkers' access to health care by expanding the number of physician assistants allowed in private practice as well as their power to issue broader medical protocols under a doctor's supervision.

Assemb. Amy Paulin (D-New Rochelle), a sponsor of the bills signed last month by Gov. Kathy Hochul, said both will help reduce a medical provider shortage statewide. Paulin said the bills also help New York get on board with other states that already have similar legislation.

The New York measures, which relax some state physician assistant standards, will ease medical doctors' workload and reduce wait times for patients, according to Paulin.

"It allows them to do more. And because they can do more, they're now going to be more attracted to wanting to practice their professions in New York because they will be able to practice their professions at the top of their license," Paulin said. "This helps everybody."

'Insufficient supply'

An April scorecard by the nonprofit Primary Care Development Corp. showed an "insufficient supply of primary care providers across New York."

To fill that gap in rural and underserved areas across the country, more health care practitioners that are not physicians, like nurse practitioners and physician assistants, also known as PAs, are stepping up, according to the National Conference of State Legislatures.

There are more than 23,000 PAs in New York who can provide medical services under the supervision of a physician, according to the New York State Education Department Office of the Professions. A medical doctor does not have to be on site. 

When one of the new bills takes effect in three months, the number of supervised PAs permitted in a private practice will increase from 4 to 6, and from 6 to 8 in "department of corrections and community supervision," according to text of the legislation.

The law will allow PAs to issue medical orders for large populations like schoolchildren, employees and nursing home residents. These orders include immunizations, treatment of opioid overdose, and treatment of anaphylaxis. The revamped PA standards also include the ability to prescribe durable medical devices, like oxygen equipment, nebulizers, and wheelchairs, to hospital patients. Currently, PA's can only do so in outpatient settings.

"You’re decreasing the amount of time and administrative burden for some of these things that are potentially life saving," said J. Scott Gould, chair of the Hofstra Northwell School of Nursing and Physician Assistant Studies.

Another provision removes the supervising physician's name on a pharmacy prescription. The provision will clear confusion for patients seen by a PA whose prescription bottle appears with the name of a supervising physician, said Jonathan Sobel, the president of the New York State Society of Physician Assistants.

More autonomy needed

A second bill, effective immediately, allows PAs to oversee radiographers delivering contrast media intravenously during X-rays or other imaging.

Sobel said he was pleased with the "modernization" of laws but believes physician assistants would gain needed autonomy by removing supervision by a medical doctor after they complete 8,000 hours of practice.

"It’s a step in the right direction. It doesn't solve everything, but it will have a positive impact on patients' access to care," Sobel said. "Continuing to move in this direction is what's important."

The number of PAs nationwide has increased — on average they see about 10.8 million patients weekly, according to a 2023 report released by the National Commission on Certification of Physician Assistants, a nonprofit PA certifying organization based in Georgia. There were 178,708 board certified PAs nationwide as of December 2023, according to the organization.

State groups representing physicians have been opposed to allowing PAs to practice without physician oversight, but accepted the recent changes as a plus.

Dr. Jerome C. Cohen, president of the Medical Society of the State of New York, in an emailed statement, said the two measures, "both take targeted steps to increase patient access to needed health care in ways that help to preserve the important physician oversight that is necessary to protect patients in healthcare delivery."

Physician assistants and scholars are hoping the changes will expedite and broaden treatment to more people on Long Island and beyond.

Donna Ferrara, chair of the Department of Physician Assistant Education at Stony Brook School of Health Professions, said, "removing some of this legislation that was in place wasn't serving our patients well, and it really can help the profession grow."