Megan Zawacki started working at St. Peter\u2019s Health in Helena, Montana, in 2020 as a physician assistant trained in treating addiction. She had gone through specialized training that allowed her to prescribe Suboxone, a medication to fight opioid addiction, but she couldn\u2019t do so for six months.<\/p>\n

That\u2019s because Zawacki was hired to work with a doctor who specialized in addiction medicine, but that doctor did not join St. Peter\u2019s until three months after Zawacki was hired, and it was another three months before he became her supervisor. Under Montana law<\/a>, physician assistants must be supervised by a licensed physician, with a supervision agreement filed with the state Board of Medical Examiners.<\/p>\n

Zawacki had an interim agreement that allowed her to begin work, but she needed that supervision agreement to prescribe Suboxone. While Zawacki was waiting, the only way her patients could get Suboxone was in the emergency room, where it costs more and comes in only a three-day supply. Zawacki said a three-day supply is meant to get a patient through withdrawal, but months of treatment are needed to end substance use.<\/p>\n

\u201cAny time that you\u2019re limiting access to care, you\u2019re putting patients at risk,\u201d Zawacki said.<\/p>\n

As Montana grapples with a health care provider shortage, state lawmakers are trying to find ways to increase access to care. One proposal up for debate is to give physician assistants like Zawacki more independence to practice unsupervised. Republican Rep. Jodee Etchart is sponsoring House Bill 313<\/a>, which would let physician assistants practice without a supervision agreement. The bill is similar to laws in neighboring North Dakota and Wyoming.<\/p>\n

Many physicians oppose the measure. Jean Branscum, CEO of the Montana Medical Association, said the bill expands a physician assistant\u2019s scope of practice with no added training requirements.<\/p>\n

\u201cThey can be in any area with no supervision,\u201d Branscum said.<\/p>\n

Yiqun Chen<\/a>, an assistant professor of economics at the University of Illinois in Chicago, said physician assistants can play a valuable role in augmenting the supply of health care providers, but not as substitutes for physicians.<\/p>\n

Chen co-authored a 2022 study<\/a> that found patient outcomes were worse when care was given by a nurse practitioner instead of a physician, and she said she believes those findings could relate to physician assistants, too.<\/p>\n

Instead of thinking of nurse practitioners or physician assistants as substitutes for doctors, Chen said, they should be integrated as part of a patient\u2019s collaborative care team.<\/p>\n

According to the American Academy of PAs, more than 750 physician assistants practice in Montana, 95.5% of them in rural areas.<\/p>\n

Etchart has been a physician assistant herself for 20 years. At the first hearing for her bill in the House Business and Labor Committee on Feb. 3, she said it would allow physician assistants to perform the work they are trained to do without the limitations of direct supervision.<\/p>\n

\u201cThis is not practicing out of our scope,\u201d Etchart said. \u201cOur scope of practice is already set at the practice level.\u201d<\/p>\n