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Healthcare reform incites greater need for medical professionals

By Melissa Kansky

Increased access equals a greater number of patients. The current healthcare climate, coupled with the  Healthcare Reform Act, produced an environment hungry for more medical care providers, according to Mark Archambault, department chair, program director and associate professor of physician assistant studies at Elon University.

The  Association of American Medical Colleges estimates in 2015 the country will have 62,900 fewer doctors in comparison to the number of citizens who will have access to healthcare. The need provokes a modification at the education level.

Elon's physician assistant master's program will enroll its first class January 2013.

"The university had already started the process and determined a program was needed and feasible," Archambault said. "The Healthcare Act just reinforced that assessment and provided further validation."

A growing need

The newly established program contributes to the expansion of programs throughout the country. Since 2007, the number of physician assistant programs has exhibited a trajectory of growth, according to the  Accreditation Review Commission on Education for the Physician Assistant, Inc.

Nationally, physical therapy programs are experiencing a similar trend. Physical therapy is the second department housed in Elon's School of Health Sciences.

"There's a trade off of slowly expanding existing programs or adding new programs," said Stephen Folger, professor of physical therapy education.

The growing number of programs translates to more physical therapists each year effectively serving the increasing number of patients.

Archambault said he recognizes the necessity for greater accessibility, which in turn creates a demand for more trained doctors.

The physician assistant programs' success is directly related to the passage of the Healthcare Reform Act, Archambault said.

The  number of applicants increased 19.6 percent from 2009 to 2010, and the number of matriculates increased 14.2 percent. But while the number of applicants continued to climb from 2010 to 2011, however that of matriculates exhibited a decrease of 4 percent.

"Healthcare is in a state where things need to change, and the goal of finding other providers who can efficiently and effectively open access to care is needed," Archambault said.

While the faculty in the physician therapy program, the second department in Elon's School of Health Sciences, questions the program's relationship to the Healthcare Reform Act, Folger predicts a change.

"I think that really it's certainly going to have an important impact on the profession but to predict the extent is difficult," Folger said.

Defining the services available

The definition of " essential service" is unclear but determines the degree to which insurance reimbursement will change, he said. Currently, physical therapy is not considered an essential service, which has the potential to impact the physician's salary.

"If we don't become one of these essential groups, there could be a reduction in physical therapy student applicants," Folger said.

Nevertheless, Folger agrees increased access to health insurance generates more physical therapy patients, producing a need for more physical therapists or effectively reducing the amount of time physicians can devote to their respective patients.

While he said he hopes the Healthcare Reform Act will positively impact the medical profession, "it puts a strain on a system that is already at its limit in some areas."

In courses, students are required to enroll in a course titled Today's Healthcare System, in which they are taught to evaluate the patient's insurance and devise an appropriate plan. Insurance plans that set limits on the number of physical therapy visits determine what treatment the physician can offer while still achieving the highest impact.

Furthermore, students work for 48 weeks in the clinic with a mentor and develop a treatment that accommodates the injury as well as the insurance plan.

"In preparing our students for that environment, you have to prepare someone who has more experience coming out and can work in that environment where they can make more careful decisions with the patients," Folger said.

Exhibiting stress in the field

Although Folger advocated for increased professional experience, Archambault identified clinical education experiences as the biggest challenge in the physician assistant curriculum.

"Our over-taxed healthcare system needs to be involved in the training of physician assistants, and the resources are stressed because of the demands put on the healthcare providers," he said.

The current conditions make it difficult for providers to accommodate pre-accepting physician assistant students nationally, he explained.

Nevertheless, Archambault argues the physician assistant model of care addresses those concerns in the healthcare system. Physician assistants partner with a physician and develop a team of providers that care for multiple patients.

Elon's program focuses on training primary care providers in the physician assistant program, according to Diane Duffy, director of clinical education.

"The highly functioning team allows each member of that team to function at their role at a high level, so they can expand their value and the services they are able to provide to patients," she said.

The current climate can also attract more students to the physician assistant profession, according to Duffy. Students can complete the program in 27 months, compared to the seven years spent in school training to be a doctor.

"PA students are able to get out and start working sooner and from a financial standpoint, that makes sense for people," she said.

Additionally, physician assistants enter the field and can fill the need more quickly, she explained.

Questions Remain

When training health science students, professors try to prepare students for the future and predict what is going to happen. But, the Healthcare Reform Act's impact on the profession is still unclear, according to Folger.

If the Healthcare Reform Act provides coverage for preventative medicine, physical therapists can increase their role, but the insurance system is designed to reimburse providers after an injury, disease or diagnosis, Folger said.

He acknowledges the Act is a large milestone with regards to redeveloping the healthcare climate but said he has yet to witness any changes.

"We're going to respond as things happen," he said.