Montana is considering allowing physician assistants to practice independently

Chen co-authored a 2022 study that found patient outcomes were worse when cared for by a nurse practitioner rather than a physician, and she said she believes these results may apply to physician assistants as well.

Instead of thinking of nurse practitioners or paramedics as substitutes for doctors, Chen said, they should be integrated into a shared patient care team.

More than 750 paramedics practice in Montana, 95.5% of them in rural areas, according to the American Academy of PA.

Etchart herself worked as a physician assistant for 20 years. In her bill’s first hearing before the House Business and Labor Committee on Feb. 3, she said it would allow physician assistants to do the work they are trained to do without the restrictions of direct supervision.

“That’s not part of our job,” Etchart said. “The scope of our practice is already established at the practice level.”

Travis Book, president of the Academy of Physician Assistants of North Dakota, said his state passed a similar bill in 2019 without much objection. Book said the law removes the administrative burden but prevents physician assistants from expanding their practice without additional training or license requirements.

According to Book, this doesn’t give physician assistants more power to practice, “it just gets rid of some red tape.”

According to Sandra DePuntis, executive director of the North Dakota Medical Council, there has been no increase in official disciplinary action against physician assistants in North Dakota under the new law.

The Wyoming law was passed in 2021. Eric Boly, president of the Wyoming Hospital Association, said he has helped fill the void left by many retiring physicians, especially in family practice and primary care.

“This is a good option for us to be able to provide primary care in rural communities,” Boli said.

The Wyoming bill provoked the same opposition that HB 313 saw in Montana – primarily physicians concerned about training and education. But Boly said he was not aware of any bad results when physician assistants were more independent.

Branscum said her group would agree to allow physician assistants to practice independently with proper training and education. She said she was worried that without a supervisor to show physician assistants what to do, patients might get worse care.

Etchart said she would consider amending the bill to require physician assistants to work under supervision for two years before practicing on their own unless they already have two years of experience after graduation.

Keely Larson is a KHN Fellow at UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is pursuing a master’s degree in environmental and natural resource journalism from the University of Montana.