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Roderick S. Hooker PhD, PA, is Director of Rheumatology Research, Medical Services, Department of Veterans
Affairs, Dallas, Texas.
Do physician assistants provide
a “social good” for America?
as the policy of physician assistant development ed to US citizens”?2 Are PAs a social good that improves the
W in America’s best interest? Professor Moore ques-
tioned whether PAs were needed, hypothesizing
that they may be cost effective in the short run but would
welfare of a nation as a whole, or do they just serve their
employers? Do PAs provide care to the underserved in com-
pliance with the intent of the Act?
negate their cost effectiveness in the long run.1 A number On the west coast, PAs and NPs provide primary care to the
of studies on the utilization of PAs have proven otherwise. underserved in higher ratios than doctors.5 In a national study
However, the literature comes up short on whether the social on seniors, PAs and NPs were more likely than doctors to
policy of introducing yet another health care provider into be the providers of elder care to those without private insur-
the mix has produced a “social good” in a way that expan- ance.6,7 A 2007 analysis demonstrated that patients who paid
sion of the physician workforce would not have achieved. medical expenses out of pocket—the poor and uninsured—were
The belief that if PAs were inefficient they would not be visiting PAs more than patients with insurance (who were
employed is the maxim that no bad news is essentially good more likely to see doctors for their care). Furthermore, patients
news. However, it fails to answer if PAs are a social good. in rural areas were found to be more likely to visit PAs than
The Health Professions Assistance Act of 1963 was de- those living in urban areas.8 Without PAs, one can suggest that
signed to stimulate the growth of the PA profession through a segment of the nation as a whole would be out of care be-
funding of Title VII, Section 747 of the Public Health Service cause of cost or access. In the aggregate, the studies demon-
Act. Policy planners wanted to supply providers for under- strate that PAs are providing care where doctors are not, and
served populations through the use of nurses, allied health the benefits are immeasurable.
professionals, and assistants to doctors.2 The plight of the PAs appear to be a public good. These and other studies
poor and underserved was a force to be reckoned with, and should bring the question of the public benefit of PAs to the
it was addressed in creative ways. The concept of the PA was fore. Social analysts can now categorically show that the cre-
not part of American medicine’s infrastructure.3 However, at ators of Title VII achieved their objective: to produce goods
the time social engineers believed the right social strategy that benefit the public by extending the reach of doctors
could lift America from its impoverished roots. Title VII through the deployment of PAs.