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Take a second to think about where you and your family go to receive healthcare — a local hospital, private practice, or an urgent care center. It might be just down the street, in the next town over, or a short drive away.

For some families in Nevada, that isn’t the case. Instead, they have to travel for hours to get to the closest healthcare provider.

That’s the reality for many patients who receive care at Kingston Health Center in Kingston, Nevada. In 2015, Ann Miles, a PA — or physician assistant — opened the rural health center through a partnership with the closest hospital. Located in the vast expanse of frontier Nevada, it’s the only option for healthcare for miles. But soon, the center’s patients may be left high and dry: Miles’ 85-year-old supervising physician, who is required to make the 240-mile trip to Kingston and back to consult with her once each month, is likely close to retirement.

Due to current practice laws in Nevada that require PAs to have an agreement with a specific physician, if her physician retired, Miles would not be able to provide care until she could enter into an agreement with a new physician. This requirement also presents challenges for PAs who want to serve in medically underserved areas since first they must find a collaborating physician and a limited number of physicians are willing to relocate or make the monthly trip to a rural practice.

For the time being, Miles’ patients can rely on her for high-quality care that used to be more difficult to come by. But across Nevada, rural areas and medically underserved communities need more easily accessible providers. And while PAs are doing their best to help fill those gaps, outdated laws are holding them back.

PAs are medical professionals who diagnose illness, develop and manage treatment plans, prescribe medications, and can serve as a patient’s principal healthcare provider. In Nevada, there are close to 900 PAs, with many practicing in rural areas.

In a recent policy brief, the National Rural Health Association explained that because 15 percent of PAs already practice in rural areas nationwide, they’re positioned to “make an immediate and substantial impact on the supply of care” — except, laws and regulations are getting in the way.

For PAs like Miles, strict requirements for how PA-physician teams must operate prevent PAs from practicing at their full potential, and keep PAs from effectively filling provider shortages in rural areas.

Alarmingly, a 2017 report issued by the University of Nevada, Reno found that ranked among U.S. states, Nevada comes in 48th for the number of physicians per capita, with just 245 physicians per 100,000 residents. And with the PA profession on the rise, the NRHA is right: PAs are in a position to help, but only if state laws and regulations let them.

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Brian Sady is president of the Nevada Academy of PAs.


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