The Importance of Physician Assistants in Geriatric Medicine
It has been almost 25 years since I and a number of my colleagues published an article entitled “Role of the Physician Extender in the Long-Term Care Setting.”1 This article was based on positive experiences that we had using both physician assistants and nurse practitioners, despite their previously limited role in any aspect of geriatric care. Both of these fields were in their formative years at that time and were still trying to become a part of mainstream medical care. Geriatric medicine was just another playing field and place to establish a presence. It has been interesting to see these two disciplines continue to evolve over the years, with subspecialization now a reality, not only for practice, but also in certain circumstances for credentialing by State Licensing Boards. Delegation agreements must be carefully crafted, and the individual’s training and experience must be judged suitable to the tasks assigned.
I have since learned that the term we chose when writing our article in 1983, physician extender, was not one that would be used today by either group, as it failed to recognize the respective fields’ unique training and abilities. We meant no disrespect at the time and were only trying to make others aware of the great potential both groups offered to allow us to hopefully meet the projected medical manpower shortage in geriatric healthcare. While clearly there were differences between these two disciplines even then, these differences have grown in magnitude over the years. Differences in training, reporting structure, credentialing process, requirements for State Licensing Board approval, salary, requirements for physician supervision, and the ability to function as an independent practitioner remain. I have always welcomed the nurse practitioner and physician assistant as full members of the multidisciplinary team, and believe that each has a tremendous amount to offer the geriatric patient at any stage along the continuum of healthcare.
I am pleased that this issue of Clinical Geriatrics includes the article “Physician Assistants in Geriatric Medicine” (page 22). The authors do an excellent job of defining the training, role, and potential of the physician assistant. As our population continues to age, we will continue to face a growing manpower crisis in terms of primary care providers and physicians willing and able to care for the geriatric patient with multiple complex problems, whether in the ambulatory setting, hospital, or long-term care facility. We must consider how best to structure practices going forward and how best to utilize our limited medical resources for the betterment of our patients. I believe that the role of the “physician extender” in geriatric medicine, whether it is a nurse practitioner or physician assistant, will continue to grow and become increasingly relied upon. Unfortunately, only a small number of physician assistants have chosen to “specialize” in geriatrics. This lack of interest clearly parallels that of physicians, with a limited number pursuing careers as geriatricians. As stated in the article, many physician assistants already incorporate the care of the elderly into their daily routine, whether it be taking care of an elderly patient in the ambulatory setting or seeing someone in the nursing home. Hopefully, many more will decide to make this a career path.
Dr. Gambert is Chairman, Department of Medicine, and Physician-in-Chief, Sinai Hospital of Baltimore, and Professor of Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.