A bill that would allow physician assistants to take on more primary care duties has turned into a battle royale between its sponsor, who chairs the House Health & Insurance Committee, and two fellow Democrats who are medical professionals .
This division also extends to the Republican caucus, whose members found themselves on opposite ends of the proposal to give physician assistants more independence in practice.
House Bill 1095 won a 10-to-1 vote from the House committee on February 23. The only “no” vote came from Rep. Kyle Mullica, D-Northglenn, a registered nurse in the emergency room at Presbyterian/St. Luke’s Medical Center in Denver.
But when the bill went to the final vote at the State House on Monday, the votes weren’t there to pass it, according to sources within the chamber. Action on the bill was postponed until Thursday.
Under the bill, the supervisory relationship between a physician and a physician assistant (PA) would change, giving the latter more independence depending on the PA’s length of practice. Once the PA has completed 3,000 hours of practice, that PA is no longer required to be in a “collaborative plan” with a supervising physician. An amendment increased this minimum to 5,000 hours; another said a physician would not be required to enter into a collaborative plan with a physician assistant as a condition of employment.
At this point, Physician Assistants are only required to consult and refer appropriate members of their health care team based on the patient’s condition, their training, experience, and skills, as well as standards of care.
The battle within the two caucuses over the bill was on full display Friday, when HB 1095 came up for second reading and a lengthy debate ensued.
Co-sponsor Rep. Susan Lontine, D-Denver, describes the fight over the bill as a “turf war” between doctors and PAs.
Rep. Perry Will, R-New Castle, said the bill would help solve a problem in rural Colorado — the lack of supervising physicians. Experienced physician assistants will be able to practice where needed, within their scope of practice, and still consult with members of the healthcare team when appropriate, he said. By contrast, under current law, experienced physician assistants are limited to providing services in the specialty area in which their supervising physician is trained, he said.
That limits care in rural Colorado, he argued, adding, “There are enough patients for everyone.”
Lontine added that physician assistants will be more employable under the bill, allowing them to use the skills in which they are trained, instead of being limited to the skills of their supervising physician. Nineteen other states and the District of Columbia have similar laws, she said. Physician assistants, who aren’t doctors, can’t do what doctors do and don’t want to do it, she said.
Rep. Yadira Caraveo, D-Thornton, a pediatrician, said the bill isn’t the answer for rural Colorado. She said she spent about 12,000 hours in training or about five years under another doctor. She supported changes to increase the number of hours, but said that still does not provide sufficient training and expertise for physician assistants to practice independently. Technically, PAs would be, as part of the proposal, always collaborate with a medical team, but supervision and collaboration are very different things, she said. With the collaboration, it’s up to the PA to decide whether or not to get a doctor’s opinion, Caraveo said.
Caraveo said that after resuming her practice after the 2021 session, she made four mistakes in two days by those she supervised, including the hospitalization of an infant. She said they had no idea they had made these mistakes and probably never would have asked her, as a collaborating physician, for her opinion. Their training does not justify changing the rules, she argued.
There are many ways to address shortages in rural areas, she added.
“What is being presented as a solution is to reduce the education requirements and hopefully fill the shortage that way,” Caraveo said, adding that it would “deter” people from going to school. medicine, because someone could practice the same way with less schooling and less debt.
The doctor runs the show, and it’s appropriate since they have the training, Mullica said.
Mullica and Caraveo said they love the AMs they work with, but this bill is a “butcher’s knife when what is needed is a scalpel…independent practice is not a solution”. They argued that it could harm patients.
Rep. Julie McCluskie, D-Dillon, said that while HB 1095 won’t solve the rural health care crisis, rural Coloradans are looking for innovative, medically sound solutions. In Summit County, without these PAs and other service providers where no one else does, children and families would be left without care, she said. In rural areas, which face dire doctor shortages, well-trained physician assistants are a complementary way to deliver high-quality, cost-effective care in a safe and responsible manner, she said.
On the other side of this debate is Rep. Lindsay Daugherty, D-Arvada, who said the bill would create a public health hazard, since physician assistants could treat patients without any supervision. She argued that the bill would not increase access to health care or make it cheaper, nor would it incentivize PAs to move to rural areas.
“If you’re talking about a rural-urban divide, this is it,” Daugherty said. “It provides substandard care to rural areas, and that’s what you’ll be doing by voting for it. If you’re in a rural area, you get a PA. If you’re in Denver, you get a doctor.”
House Republicans are equally divided between those who believe rural Coloradans need the care that a PA would provide, and those who argue that it would not encourage PAs to move to rural areas or leave rural Coloradans with substandard care .
On the one hand, Representative Richard Holtorf, R-Akron, who supports the measure.
“This bill is one of the toughest and most complicated bills around,” Holtorf said.
He said that within the confines of his district there are small towns of 50 or 500 people near the borders with Kansas, Oklahoma or New Mexico, which are struggling to attract medical professionals.
“We can’t get medical care because we don’t have the doctors [to provide it]”, he said. “Some treatments are better than none.
He added that he would support any type of health care in these areas.
On the other side of that argument is Rep. Matt Soper, R-Delta, who sits on the board of a Delta County hospital, who argued the bill would continue the war on Colorado. rural by creating a substandard class of care for rural hospitals.
“We can get physician assistants already. The real struggle is getting physicians,” he said. “I don’t want to treat rural Colorado like an ugly son-in-law.”
The bill does not just divide caucuses. The medical community is also deeply divided.
The opposing party includes the Colorado Medical Society, the American Academy of Pediatrics; COPIC, which provides medical liability insurance; professional organizations representing emergency physicians, psychiatrists, anesthesiologists, radiologists, ophthalmologists and Kaiser. On the support side are Physician Assistants, Colorado Community Health Network, Colorado Center on Law and Policy, Colorado Rural Health Center and United Healthcare.
The bill was amended in a committee hearing to add a petition clause, which would allow citizens to challenge the law with a ballot measure if it was tabled within 90 days of the end of the session.