How PAs improve access to care for the underserved.

Objective: Increasing health care costs and inaccessibility to care create barriers to physicians' services. The physician assistant (PA) profession developed in part to help care for underserved populations. The objective of this study was to test the hypothesis that poorer patients in outpatient clinics are more likely to see PAs than physicians.

Methods: A retrospective analysis of National Ambulatory Medical Care Survey data (1997-2003) on outpatient physicians and their office staff was carried out. Weighted logistic regression analysis was used.

Results: After adjusting for covariates such as patient age, gender, race, year of visit, and region, patients covered by Medicare insurance had lower odds of visiting PAs compared to patients possessing private insurance (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.29-0.81). Further, patients who paid out-of-pocket had higher odds of visiting PAs compared to patients with private insurance, after adjusting for potential confounders (OR: 1.37; CI: 1.18-1.77). Patients in rural areas were more likely to visit PAs than were patients in urban areas (OR: 2.02; CI: 1.31-3.14).

Conclusion: Considerable use is made of PAs in all settings, and they tend to be utilized in otherwise underserved, rural populations who do not have health insurance.