Physician assistants will return to Beacon Hill this year to advocate for the removal of “archaic” requirements that, they say, will make a difference amid the commonwealth’s primary care bottleneck.
The Massachusetts Association of PAs wants state legislators to make permanent COVID-era accommodations that eliminate the legal requirement for physician assistants to register a specific supervising physician with the state.
The idea is physician assistants would be able to practice to the fullest extent of their license by not being beholden to just one physician. Proponents argue it would deploy much-needed flexibility across a health care system plagued by a primary care doctor shortage, where data shows just 40% of Massachusetts patients’ needs are being met.
Duncan Daviau, an emergency medicine physician assistant (PA) at Mercy Medical Center in Springfield and president-elect of the Massachusetts Association of Physician Assistants, said his profession represents some of the “strongest and most resilient providers” who frequently get into the business for the very purpose of increasing access to health care.
It’s time to update the supervisory model so they can do just that, he said.
“Our license being appended to one individual is kind of archaic and outdated,” Daviau said.
A handful of proposed legislation this session would achieve the association’s goal, including SD 258, HB 774 and a broader primary care package.
Last year saw “a lot of progress,” with the bill being reported out favorably by the Senate committees on health care financing and ways and means, Daviau said. But last year, the collapse of Steward Health Care across the state took precedence for legislators when it came to priorities, he added.
In April 2024, physician assistant students and providers advocated for more flexibility in their licensure requirements during a lobby day organized by the Massachusetts Association of Physician Assistants.(Alison Kuznitz/State House News Service)
Thea Nolan, an interventional radiology physician assistant at UMass Memorial Health and current president of the state association, cited positive momentum because of what she sees as a shift in how PAs are viewed — by physicians and the public.
“There’s more camaraderie between physicians and PAs, and less of that historical hierarchy,” she said. “More and more, physicians are recognizing our value as partners in care and that has been incredibly validating.”
A report published earlier this year by the Massachusetts Health Policy Commission said as fewer physicians are going into primary care and many are exiting the profession altogether or retiring, physician assistants are increasingly involved with providing care.
At the state’s community health centers, data shows the number of nurse practitioners and physician assistants now exceeds the number of physicians.
“But Massachusetts has been slow to integrate (PAs) into practice,” said the report, which recommends shifting the supervisory requirement from an individual physician to the employer or practice.
The effort does, however, face opposition from the Massachusetts Medical Society, the largest physician-led organization in the state that could have some hefty lobbying power.
“While physician assistants play a critical role in the health care system, physician-led, team-based care — including physician assistants — is the optimal model for achieving the best patient outcomes,” association President Dr. Hugh Taylor said.
“Supervisory requirements are not merely administrative constraints, they are essential to protecting patient safety and to ensuring patients have access to physician-led care teams.”
What physician assistants do
By definition, physician assistants are licensed clinicians with master’s-level degrees who practice medicine in varying specialties and settings under a supervising physician.
Daviau and Nolan described PAs as being part of a collaborative, team-based care model that includes several partners, including physicians, nurse practitioners and others working together for the good of the patient.
During the COVID health emergency, in early 2022, a temporary executive order under then-Gov. Charlie Baker allowed the state’s more than 4,000 PAs to practice without physician supervision. At Mercy Medical Center, Daviau said, that enabled PAs of all specialties to “join the frontlines” for a better pandemic response.
But the accommodations have since expired, and the state’s primary care crisis has worsened. In 2023, two-thirds of people seeking care in emergency departments said they were there because they couldn’t get an appointment in a doctor’s office or clinic, according to the state’s Health Policy Commission.
“COVID forever changed the landscape of health care in so many ways, but I think we have to talk about the good things that came from it,” Nolan said, “and one of them is that people are speaking up more and advocating for improving health care. Crucially, that call for better care includes making sure PAs are part of the solution.”
Twenty other states — including Connecticut, Maine, New Hampshire, Rhode Island and Vermont — have eliminated strict physician-to-PA supervision ratio requirements, according to a 2024 University of California Irvine School of Medicine study.
The legislation in question
Sen. Julian Cyr, D-Cape & Islands, sponsor of SD 258, emphasized his bill doesn’t grant independent practice authority to physician assistants. Rather, it gives “health care institutions increased flexibility to use PAs.”
He sees it as one mechanism to assist the chaotic primary care landscape in the state, which was a centerpiece of Gov. Maura Healey’s State of the Commonwealth speech in January.
Rep. Christine Barber, D-34th Middlesex, has introduced similar legislation in the House.
“My constituents are desperate for primary care providers to be taking new patients,” Cyr said. “I think many folks may not even know the difference in practice (of PAs). The physician supervising of PAs is not much more than something on a piece of paper.”
Sen. Julian Cyr, D-Cape & Islands(Sam Doran / State House News Se
Cyr expects the state will be increasingly reliant on providers such as physician assistants to administer primary care because of a medical system that he views as incentivizing doctors to pursue specialties.
According to the Massachusetts Health Policy Commission, the share of physician assistants and nurse practitioners in primary care rose from 26% to 31% between 2018 and 2022.
Cyr said most patients in Massachusetts seek “just anyone who can provide basic care,” whether it be a physician, physician assistant or nurse practitioner.
In Western Massachusetts, for example, the Caring Health Center in Springfield has a 2,000-person waiting list.
Nolan of the state’s physician assistants association cited one Mass General Brigham clinic with 3,000 people on its waitlist.
“It’s wild, but honestly, it reflects what many of us are seeing across the board,” Nolan said.
Responding to the Massachusetts Medical Society’s opposition to his bill, Cyr said physicians have an interest in “maximizing the market share.”
“But the commonwealth has an obligation to make sure patients can access primary care,” he said.
Mass. Medical Society says patients want physician-led care
Taylor, president of the Massachusetts Medical Society, cited data from American Medical Association (AMA) polling showing that 95% of patients want physicians to be involved in their care.
The AMA argues that scope of practice expansion, or “scope creep,” threatens patient safety. “Patients deserve care led by physicians — the most highly educated, trained and skilled health care professionals,” its website reads.
While the Massachusetts society is focused on the state’s primary care crisis, Taylor argued the systemic issues causing it won’t be solved by “shifting clinical responsibilities away from physicians.”
He contended not enough PAs are involved in primary care in the state to make much of a difference, either.
“With only 16% of PAs in Massachusetts working in primary care, expanding scope of practice will have little impact on improving patient access to care,” Taylor said. “Expanding scope of practice for non-physicians has not been shown to guarantee increased access to primary care for patients in underserved and rural areas. We must drive holistic policy solutions that will ensure long-term sustainability of the primary care system, addressing the administrative drivers of burnout among primary care physicians and increasing investments in primary care.”
Taylor cited “extensive education and training” that equip physicians with the expertise “to supervise health care teams delivering care to a patient population that is increasingly sicker and more medically complex, improving the ability to provide a differential diagnosis when a seemingly common ailment is something more rare or serious.”
