We have all felt the frustrations of attempting to maintain the highest standards of medical practice in an environment that has made it increasing difficult to do so. Dr. Lema voiced several concerns about their use. The greater concern that Dr. Lema raises is quality of care. He fears that if patients are initially evaluated by individuals who do not have the physician s education and experience, new syndromes will not be recognized. They are trained in the medical school paradigm to practice collaboratively with physicians.
PAs are well-acquainted with normal historical, physical and laboratory findings.
When the constellation of positive findings are outside the individual PAs experience level, the PAs consult the physician. I do not think that quality of care should be a point of concern. Conversely, by having the knowledge and experience of two individuals, it may be less likely for there to be oversight. Additionally, by sharing the patient load, the physician is likely to be less stressed and be better able to provide consultant services. Dr. Lema s other comment concerns Medicare billing to PAs.