The House is considering H.116, an obscure bill that could erode the quality of health care in Vermont by sweeping away the licensure structure for Physician Assistants (PAs).

Currently, PAs submit a “delegation agreement” to the Board of Medicine that identifies a doctor to “oversee and accept responsibility for” the PA. This is, in effect, an apprenticeship agreement, recognizing that PAs are not ready to practice on their own when they graduate from their abbreviated, two-year version of medical school.

H-116 would completely eliminate this agreement for any PA practicing in a hospital or a health center, and drastically weaken it for private practice. The proponents of this bill, no doubt, suggest that we can quickly increase numbers of primary care providers, but at what cost? Even the American Academy of PAs has stated it does not support the idea of independent practice, which is too much like what this bill would enable. New Hampshire similarly floated the idea of licensing physicians right out of medical school, without a residency: the idea was rejected and quite rightly.

This bill will pass oversight of PAs from doctors, with clinical expertise, to administrators with expertise in spread sheets. PAs need time and training in actual practice, but this bill will create intense pressure to quickly increase the numbers and caseloads of novice PAs to cut costs. This is a great idea for the balance sheets, but a terrible idea for the safety of patients.

Russell Payne


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