Physicians’ Assistant Trend in the Emergency Department Presents Increased Liability Issues

side note: This is a trend worth mentioning. As hospital systems as well as many private practices try to maximize profitability in the face of diminishing reimbursements, the healthcare field has seen an increase in the utilization of physician assistants. What new risk exposures does this trend present? Who is responsible for the actions of the PA? What does this imply for the future of medical malpractice insurance with regard to PAs?

One trend occurring in emergency departments across the country is an increased use of physician’s assistants (PAs) to diagnose and treat patients. While this practice minimizes staff costs and reduces the burden on primary care physicians, hiring more PAs could expose hospitals to more medical malpractice claims due to mistakes like medication errors or misdiagnoses.

According to the American Academy of Physician Assistants (AAPA), between 1996 and 2008, the percentage of PAs practicing in family medicine dropped from 39.8 percent to 25.9 percent. This decrease correlates to the movement of many PA jobs into specialty areas, like emergency departments, which more patients are visiting every year. The U.S. Department of Health & Human Services (HHS) data shows that from 1996 to 2006, patient use of emergency rooms rose by 32 percent, creating issues such as overcrowding and longer wait times.

As reported by HHS, PAs treat around 10 percent of all emergency room patients annually. Both hospitals and patients have benefited from the increased use of PAs in emergency departments. Some advantages are lower costs for staff and medical care, shorter wait times, briefer stays, more personal attention for patients and the ability of physicians to focus on more critical patients. However, many in the healthcare industry think this movement toward hiring more PAs can compromise the quality of patient care and create additional risks for malpractice.

While emergency department PAs operate under the supervision of primary care physicians, there is still the possibility of medical errors. According to one medical liability study performed by the National Practitioner Data Bank (NPDB) in 2008, there were 1,535 reported medical malpractice payment incidents against PAs between 1991 and 2007. The average payout cost medical providers around $80,003. Although this number was significantly lower than reports and payments for physicians, there were multiple areas where PAs made medical errors.

According to the NPDB study, the five major categories where PAs received the most malpractice reports were in the areas of diagnosis (55.5 percent), treatment (24.6 percent), medication (8.5 percent), surgery (4.6 percent) and miscellaneous (3.1 percent).