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PA Practice Is Well Suited to Support Rural Healthcare Communities

David J. Bunnell, MSHS, PA-C

Disclosures

February 28, 2022

An individual's ZIP code in the United States can be their barrier to health equity. I once suggested to a legislator in a rural community that when lobbyists from one healthcare profession approach him trying to diminish another in their talking points that he would do well to ask himself why they aren't discussing how they can work together for the benefit of people he represents. Physician assistants/physician associates (PAs) were created with team collaboration in our professional DNA, and we represent a workforce that can help to work toward rural health equity.

A recent electronic health record study in a Midwestern healthcare system found that rural patients don't use outpatient primary and specialty care services as often as those in other areas despite having an increased incidence of chronic medical problems. In a 2011 systematic review of 51 papers over 35 years, PAs were found to be well suited for practice in rural areas, with good acceptance in the community by patients and physicians.

To this end, the Center for American Progress, an independent nonpartisan policy group, discussed improving legislation enabling PAs and advanced practice registered nurses (APRNs) to gain more practice authority as a part of solutions to expanding healthcare access to rural communities. The National Rural Health Association identifies improving enabling legislation and reimbursement for PAs and APRNs to be a priority to fulfill their mission of supporting rural communities.

There are also economic benefits to rural communities in terms of attracting provider and support staff as well as the businesses that serve them. When a PA or NP is part of a primary care team, the rural economic impact of clinicians working at 75% capacity ranges from $280,476 to $940,892; the higher figure depends on whether the provider sees patients in the hospital as well as the clinic.

This support for the bottom line represents financial viability for communities and businesses. These are people who are buying houses and cars, participating in the local school system, joining places of worship, and volunteering in vital organizations that are the lifeblood of rural America.

In a meeting with a rural hospital medical staff, I once advocated for PA student clinical rotations. I was warned that a respected physician with lifelong service to the community was skeptical about PA practice. I was not surprised when he shared his skepticism with me. After explaining he would rather be working with a physician, he added that his community really needed help. He asked me to find a seat at the table so we could talk about how we could work together. PAs are always glad to discuss how we can work with physicians for the benefit of patients, because that is what we do.

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About David J. Bunnell, MSHS, PA-C
PA Bunnell's clinical experience is in cardiac electrophysiology, cardiothoracic surgery, and surgical critical care. Prior to becoming a PA, he was a paramedic, organ recovery coordinator, and research coordinator. He serves in PA leadership and advocacy roles to communicate the profession's value to patients and healthcare systems as well as to encourage the PA community to continue to do amazing things.

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