Part 2: A Reader Responds to "Does Primary Care Matter?"

Margery Bower, PA-C; Emily Friedman


January 09, 2009

To the Editor:

Working as a physician assistant (PA) in primary care, I believe in the need for primary care physicians. I am a PA, hence I cannot speaking for nurse practitioners. PAs were developed as members of the physician-directed medical team.[1] I chose the PA profession to be able to practice medicine to the limits of my training, to practice medicine with a physician, extending their availability by assuming some of the care of their patients.[2] I do have access to the supervising physicians in our office, but everyday I have to make decisions: which patient is the most sick today, to take the physician's time, and which patients I can manage. There is talk that PAs are jockeying to fill the primary care shortage,[3] but not without the support and training of supervising physicians.

I would like to see training for primary care medical doctors in supervising PAs. This can be part of medical school, residency, and CME modules. Is my experience of the PA setting the limits of their practice, and then engaging the physician-PA team if needed, the best way to be supervised? Behind every PA is a supervising physician; let's work to make the team stronger.

In my office, the best-cared-for complex patients are patients whom PAs share with an MD. There is a concise, physician-directed (utilizing PA input) patient management plan in place. The brief discussions between the PA and physician concerning the patient are invaluable teaching/learning tools for both of us. Patients benefit from 2 providers familiar with their conditions, as well as better provider availability.

PAs are not medical doctors, but they are an important part of primary care. I agree with Emily Friedman when she wrote about getting more physicians interested in primary care and that we don't need a turf war.[3] We need to utilize the best that physicians have to offer by enhancing their supervision of PAs and developing a stronger physician-directed physician-PA team to assure that all patients get timely, comprehensive, quality care.

Margery Bower, PA-C
Plainfield, Vermont


  1. American Academy of Physician Assistants. Issue Brief: The physician-PA- team. Available at: Accessed November 2, 2008.

  2. Desai SR. The benefit and burden of ancillary professionals in dermatology. Virtual Mentor. 2006;8:514-516. Available at: Accessed November 2, 2008.

  3. Friedman E. Does primary care matter? Medscape J Med. 2008;10:209. Available at: Accessed November 2, 2008.

Author's Response:

To the Editor:

I agree with Ms. Bower about the important role of the physician's assistant on the primary care team. The role of members of this profession will only grow as the shortage of primary care physicians becomes more acute. Although the term "physician extender" is, in my opinion, a bit demeaning, I do believe that many primary care activities can be and should be performed by PAs. I also agree that physicians should learn supervisory skills as part of their education -- not just supervision of PAs, but also of other allied health professionals and of nurses, when supervision is appropriate. If we can reduce the tension that exists among various care-giving professions, everyone will benefit.

Emily Friedman
Independent Health Policy and Ethics Analyst
Chicago, Illinois
Adjunct Assistant Professor
Boston University School of Medicine
Boston, Massachusetts

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