Susanna Storeng loved working with patients as a physician assistant in Lamar, a rural farming and ranching community along the Arkansas River in southeastern Colorado.
She said she felt right at home in that setting, providing much needed primary care and building strong relationships with people who trusted her for care, from routine check-ups to contraceptive services.
“It fits that mission of providing for the underserved that the (physician assistant) profession was founded on,” Storeng, who until recently was the chief clinical officer at High Plains Community Health Center, said. The profession has its roots in the 1960s when the passage of Medicare and Medicaid created a new group of people seeking health care, demanding an increase in providers.
Physician assistants are licensed clinicians who are able to directly examine, diagnose and treat patients.
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Storeng and her family, however, made the decision to move back to Michigan when she found herself professionally limited in Colorado by laws that dictate how and where a physician assistant can practice. Under current law, they must be connected to a supervising physician within their specialty who actively participates in the same procedures.
Lawmakers are on the verge of changing that relationship into a more collaborative agreement, however, which supporters say would be a more accurate reflection of how modern health care works. In simple terms, it would allow physician assistants to perform procedures they have extensive experience with that their collaborating physician doesn’t necessarily engage in.
For Storeng, things came to a head when she became unable to perform certain contraceptive care, such as placing intrauterine devices — known as IUDs — and the contraceptive implant Nexplanon despite having training and years of experience doing so.
The supervising physician at her clinic, who was also trained and experienced in those procedures, left. The new physician did not place IUDs or Nexplanon — among other procedures — rendering Storeng unable to provide those services for her patients. That was at the end of 2021.
“And then what happened? Roe v. Wade was overturned. Rural Colorado has some of the highest rates of teen pregnancy, and you basically cut contraceptive care from one of the only providers who can do Nexplanon and IUDs,” Storeng said.
She had patients who trusted her for their primary care who wanted to change their contraception, either by implanting or removing devices. But because Storeng could no longer do that for them, she needed to refer them to another provider. A simple procedure that could happen in minutes in Storeng’s exam room was then delayed by appointment waiting times and another copay, and potentially axed all together by patient hesitancy and other factors unique to rural life, like transportation issues.
Additionally, the clinic faced some recruitment challenges for another physician supervisor, and physician assistants were at risk of losing their jobs. Storeng is the sole provider for her family, and she said her multifaceted decision to leave Lamar was heartbreaking.
“But my husband and I decided we couldn’t take the risk. I decided to resign and go to a state that has more friendly PA practice laws,” she said.
Bipartisan bill would alter physician assistant relationship
A bill that could have altered things for Storeng is now poised to pass the Legislature.
Senate Bill 23-83, sponsored by Republican Sen. Cleave Simpson and Democratic Sen. Faith Winter in the Senate and by Democratic Rep. Dafna Michaelson Jenet and Republican Rep. Ty Winter in the House, would expand a physician assistant’s ability to practice by changing the supervisory requirement into a collaborative agreement with a physician or physician group.
It’s something that 20 other states have already done.
“At the end of the day, what we are trying to do is make sure that we are expanding access to well-qualified health care individuals throughout Colorado,” Faith Winter said during the bill’s first committee hearing in early March. “We are trying to ensure that these physician assistants, that go through a lot of training and education, can actually practice their skills and expertise without being tethered to one single physician.”
PAs are trained to practice in all areas of medicine. That is the beauty of our profession — we’re flexible and can meet needs where they are.
– Alyn Whelchel, previous president of the Colorado Academy of PAs
There would still be a supervisory agreement for new physician assistants with fewer than 5,000 practice hours or one with fewer than 3,000 practice hours in a new speciality.
The physician, group or employer would have ultimate oversight responsibility and could structure the collaborative agreement as restrictive as they see fit for their practice.
The bill passed both chambers and is waiting for Senate approval of amendments made in the House, one of which requires a supervisory agreement in level 1 and level 2 trauma centers. It was laid over for the third time on Thursday in the Senate.
“PAs are trained to practice in all areas of medicine. That is the beauty of our profession — we’re flexible and can meet needs where they are,” said Alyn Whelchel, the previous president of the Colorado Academy of PAs.
That means they might change jobs and acquire new skill sets. Supporters of the legislation say it is best for patient care that physician assistants are able to take that knowledge and use it wherever they are. In some instances, like for Storeng, their skill set in some areas could be higher than a physician they work with.
“This would allow a tremendous amount of flexibility at the practice level for who can be linked to that PA so that they can keep their job,” Whelchel said.
She said the bill reflects the modern reality of health care. In the early decades of the physician assistant profession, it was more common to have one-on-one partnerships with physicians who owned their own practice. Now, team-based health care is the norm, yet the supervisory requirement doesn’t necessarily reflect that.
The bill could impact provider access in rural Colorado, which often faces more intense health care workforce shortages. Non-physician providers like physician assistants and nurse practitioners can, and do, fill gaps in the health care system.
“Most of the health care that is being provided in rural communities is primary care. That can be provided safely and effectively by advanced practice providers like a PA,” said Kelly Erb, the associate director of policy and advocacy at the Colorado Rural Health Center.
This is not the first bill on the subject to be introduced in the Legislature. A similar bill, also sponsored by Simpson and Faith Winter, lost in the House on second reading last year. In 2021, the bill didn’t even make it through committee.
This year, the bill makes it clear that physician assistants cannot be a majority owner in a practice and cannot run their own practice without a physician.
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