Physician assistants showing up in every specialty

SPRINGFIELD, Mo. -- Bronchitis, sore throats, runny noses. Diabetes, hypertension. A sympathetic ear. Then it's on to the nursing home to see more patients.

It's all in a day's work for Elton Youngblood.

Call him anytime -- he loves the job and has always dreamed of practicing medicine.

Just don't call him "Doctor."

Youngblood is a physician assistant, or PA. A two-year medical training program and a state board exam certifies him to perform routine medical care under Dr. Kimberly Witkop's supervision so she has time for the sicker patients in her Branson office.

Across the Ozarks, chances are a PA has treated your mother's flu or sutured your neighbor's knee in surgery.

PAs are showing up nationwide in every medical and surgical specialty and health care setting -- prized because they can extend the physician's healing hand in an overextended industry.

In the Ozarks, PAs staff hospitals and urban and rural clinics from Bolivar to Branson, Springfield to El Dorado Springs and beyond. Cox Health Systems use 11 PAs; St. John's Health System has 21.

Officials at Cox and St. John's expect to hire more.

More access to patients

"At a time when the demand for specialty care is greater than physicians coming out of schools, it's a way to provide more access to patients without in any way degrading the quality of care," said Steve Edwards, senior vice president of Cox Regional Services.

Springfield allergist Dr. Gregory Lux has worked with PA Dave Renner for nearly four years.

"What it does is allow more patients to get into the office," Lux said, "and those with special needs he brings to me and we work out a treatment plan and he carries it out."

Patients accept PAs as part of the medical team. They can get appointments easier, and they like the personal attention that PAs can give, advocates say.

PA Bobby Eden shares hospital rounds with trauma surgeon Dr. Kenneth Larson at St. John's Regional Health Center when they're not seeing patients or in surgery.

"Patients don't feel we're blowing in and out of the room at light speed," Eden said. "Suddenly instead of seeing 15 patients, we're each seeing seven or eight, and we have more time to spend with them."

Patients typically pay the same for an office visit with a PA. At that level of routine care, doctors say, the quality of care is virtually the same. The physician is still nearby if needed.

PAs emerged from the military and went mainstream to relieve a physician shortage in the mid-1960s.

There is no organized opposition to PAs, though some groups successfully lobbied the Missouri legislature in the 1990s to prohibit them from operating off-site.

Growth projection

Today it's one of the 15 fastest-growing occupations in the country, said Nancy Hughes, with the Arlington, Va.-based American Academy of Physician Assistants.

"On one hand we have a population that's getting older, and as you get older you use more health care," Hughes said. "Then we have a pressure on our health services system to provide more care in the most most-effective manner."

The U.S. Bureau of Labor Statistics projects that PA jobs will grow by 53 percent from 2000 to 2010, while it expects the total number of U.S. jobs to grow by 15 percent.

It can be lucrative: Base salary in the Midwest is $55,000 plus benefits.

"But you've got some PAs in the cardiovascular area making six figures, easily," said Lori Barnes, a recruiter for St. John's Health System.