April 28, 2016

PAs Key to Better Healthcare in Kentucky

Edward J. Timmons

Associate Professor of Economics, Saint Francis University
Summary

The commonwealth of Kentucky is famous for many great things: fried chicken, a major horse race and baseball equipment, to name a few. Unfortunately for the citizens of the Bluegrass State, it is also the only state that does not allow physician assistants to prescribe controlled substances.

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The commonwealth of Kentucky is famous for many great things: fried chicken, a major horse race and baseball equipment, to name a few. Unfortunately for the citizens of the Bluegrass State, it is also the only state that does not allow physician assistants to prescribe controlled substances.

According to the U.S. Census, Kentucky has a larger share of its population in rural areas than most other states. More than 40 percent of its population resides in a rural area – and just seven states have larger rural populations. According to data collected by Syracuse University, Kentucky has two counties (Carlisle and Owsley) with zero physicians. Residents of these counties may have to travel significant distances to find health care. In addition, research conducted by the University of Kentucky Medical School indicates that more than two-thirds of the counties in Kentucky (81 out of 120) have a shortage of medical professionals.

Unfortunately for Kentucky residents, it has been well documented that physicians often prefer to live in urban areas. It’s therefore unlikely that the state can resolve the lack of access to health care in its rural counties with new physicians.

Advancements in technology can help fill in some of these gaps. Telemedicine, in many instances, can allow rural patients to access top medical specialists at a relatively lower cost. In some cases, however, patients require face-to-face meetings with medical professionals.

The fact that Kentucky is now the only state that does not allow physician assistants to prescribe controlled substances is certainly not helping the situation. In a recent research paper that I authored for the Mercatus Center at George Mason University, I document whether each state allows physician assistants and nurse practitioners to prescribe controlled substances. The results suggest that granting physician assistants broader prescriptive authority is associated with outpatient Medicaid costs decreasing by 11 percent.

Granting physician assistants further autonomy will allow them to better serve patients. Kentucky should consider granting its nurse practitioners further autonomy as well. Several states allow nurse practitioners to prescribe controlled substances without physician supervision – effectively letting nurse practitioners to practice autonomously. Kentucky does grant nurse practitioners some degree of autonomy, but this change would allow nurse practitioners to viably substitute for primary care physicians.

Certificate-of-need laws, which are in place in Kentucky, also are not helping rural residents. Recent research suggests that that these laws work to reduce access to health care for rural residents.

Kentucky faces many of the same challenges as other states with large rural populations. Yet it is making a mistake by standing apart from them by not allowing physician assistants to prescribe controlled substances. Reconsidering this stance and removing some of the barriers present in the market for healthcare would go a long way to improving access to care for rural residents of the Bluegrass State.