Some physician assistants are pushing state lawmakers to support expanding their autonomy, as was done in the early days of the COVID-19 pandemic.

Gov. Kathy Hochul's budget proposal includes eliminating supervision requirements for PAs working in primary care medicine and some other non-surgical specialties with 8,000 clinical hours. Similar bills have been proposed by the Legislature, and the measure was proposed last year by the governor.

Edward Mathes is president of the New York State Society of PAs. He is urging state lawmakers to support Hochul’s budget proposal, saying that it would allow PA’s to use their training, education and experience to improve health care resources.

“It will allow us that flexibility to move into areas of need,” he said.

The U.S. Department of Health & Human Services says 6.5 million New Yorkers live in healthcare professional shortage areas (HPSA). Mathes said 40% of PA’s serve patients in the zones, and he feels the proposal will help provide them with reliable care.

“Our primary concern is access to care, getting into the more rural areas, federal-qualified health centers,” he said. “In the more rural reaches of the Finger Lakes, up in the Adirondacks and the Catskills, we have health care deserts.”

There is strong opposition to the proposal from others in the field.

Dr. Paul Pipia is president of the Medical Society of the State of New York.

He says the organization’s position is clear: PA’s are not a substitute for trained physicians, and the solution to New York’s health care workforce shortage is to make the state a better place for physicians to work, rather than relying on PAs to provide the same degree of care.

“They’re a valued member of our team, but they need to have the physician drive the patient's care,” he said.

Pipia cited an American Medical Association study finding that when PA’s were allowed to practice independently at a clinic in Mississippi, patients experienced higher costs due, in part, to the ordering of more tests and the issuing of referrals to other professionals.

He stressed his fear is that should this become law in New York state, some patients will have access to an accumulated level of knowledge and expertise that others may not.

“You’d be setting up a two-tier system if you let PA’s practice independently. They don’t have the same amount of training,” he said. “My residency was 16,000 hours, and the proposal is to let them practice independently at 8,000 hours.”

In response, Mathes said PAs accumulate experience overtime that could be better utilized.

“We acknowledge that a physician’s education is greater than ours,” he said. “Our broad-based education does allow us to see general health issues with patients, and as you gain that experience, certainly, your autonomy increases anyway, and you’re able to manage more complicated patients.”

In addition to a health care question, it is also considered an education issue. Bills supporting removing the supervision requirement were sent to the Higher Education Committees in both chambers this session.

Assembly Member Patricia Fahy, who chairs the Higher Education Committee, said some degree of change could help address health care workforce shortages.

“I support the need for limited flexibility and targeted changes in PA supervision, similar to those allowed during COVID, in an effort to address these urgent health care workforce shortages — which is fueling unprecedented delays at hospitals, emergency rooms, and primary care providers, especially in our upstate communities,” she told Spectrum News 1.

We reached out to other lawmakers that will be weighing in as the budget process continues, but have not heard back.