When you go to an urgent care center or the emergency room for help, you might not actually be seen by a doctor. The person examining you is wearing a white coat or scrubs and a stethoscope, but could be a physician assistant. That’s OK if you have a minor ailment; otherwise, it could cost you your life.
George Trovato, 39, went to an urgent care center in Wading River for joint pain. A PA told him to start an exercise routine and sent him home. Two weeks later, he was dead from a heart attack. His wife is suing, claiming he didn’t know he wasn’t being seen by a doctor and didn’t get the diagnostic tests that might have saved his life.
Yet New York Gov. Kathy Hochul is pushing to allow PAs more freedom to practice without a doctor’s supervision, worsening the danger that already exists. Right now, the law requires PAs to be supervised, though that can mean a review of patients’ charts many hours after the fact. Supervision requirements went by the wayside during COVID-19. Hochul’s proposal would codify letting PAs do almost everything a physician does, including diagnosing, without review.
After many tragedies, the UK’s National Health Service is doing precisely the opposite. On Jan. 28, the NHS announced it will reduce the use of PAs and bar them from treating undiagnosed patients.
Overreliance on PAs has been a front-page tabloid issue in the UK ever since 30-year-old actress Emily Chesterton died from a blood clot in her leg that was missed by a PA during two visits. Chesterton thought she was being seen by a doctor. The PA incorrectly diagnosed her with a sprained calf and “long COVID-19,” then sent her home. After she succumbed to a pulmonary embolism, the coroner concluded she should have been sent to a hospital emergency center.
Diagnosis is the danger point. Becoming a physician requires at least four years of medical school plus one or several years as a resident in training at a hospital. It’s the years of study in biology, chemistry, and bodily systems that enable a doctor to diagnose the less common cause of a set of symptoms.
Syracuse University researchers show that “the truncated training period of PAs relative to physicians contributes to a higher average diagnostic error rate.” They explain that “PAs typically compare favorably to physicians in terms of post-diagnostic care.” But you need to be seen by a doctor to analyze your problem first.
It’s a problem because a quarter of the time, American patients are now being seen by nonphysicians. They need to be informed of that and know when it’s a danger.
PAs came on to the scene in the 1960s in response to the beginning of a doctor shortage, which is ongoing. Large hospital systems and outpatient care centers began hiring them because they are cheaper. They cut the wait time to be seen, and many argued they would reduce overall costs to the health care system.
But now the evidence shows that using PAs comes with a cost. The Syracuse researchers warn of a “lower quality of diagnosis and treatment in the healthcare system.”
There’s no question the U.S. has a physician supply problem. The Association of American Medical Colleges estimates that the nation will be short 86,000 doctors by 2036. The causes are too few incentives to attract young people to the profession, and too few residency programs funded by the government to accommodate medical school graduates.
Both of these problems are fixable. Becoming a doctor in the U.S. requires 11 to 19 years of graduate school and hospital training, and students graduate from medical school with $200,000 of debt, on average. That is being remedied.
New York University Grossman School of Medicine made history in 2018 by offering free tuition to all its admitted medical students, thanks to a $200 million bequest from Elaine and Kenneth Langone. Several other distinguished schools have followed, including Johns Hopkins University, Case Western Reserve University, and Albert Einstein College of Medicine. Anyone interested in donating to improve health care in the U.S. should consider supporting medical education. Increasing the supply of educated caregivers is far better than lowering standards.
Medicare funds the residency programs, and the number of slots can be increased by federal lawmakers. Congress foolishly downsized that number in the 1980s and ’90s on the erroneous belief that more doctors would encourage unnecessary health care consumption. In fact, the doctor shortage has led to unwise remedies such as overreliance on PAs.
All over the country, governors and legislators are being pressured by the American Academy of Physician Associates, a lobbying group, to blur the distinctions between physicians and PAs. Hochul should realize that New York is one of the medical capitals of the nation. Lowering the standard of care will imperil that reputation and put New Yorkers’ lives at risk.
Betsy McCaughey is a former Lt. Governor of New York State and Chairman & Founder of the Committee to Reduce Infection Deaths. Follow her on Twitter @Betsy_McCaughey.
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The opinions expressed by columnists are their own and do not necessarily represent the views of AMAC or AMAC Action.
Sigh. This piece is riddled with inaccuracies, and it’s hard to understand why a former New York lieutenant governor would write it. To start, we are not the UK. Leading with a UK case is a disservice to U.S. PAs, who are trained differently, regulated differently, and held to a single national certification standard.
And the real‑world evidence is impossible to ignore. During the COVID‑19 emergency, New York and several other states temporarily suspended supervisory requirements. What happened? No spike in malpractice claims. No surge in disciplinary actions from the Office of Professional Medical Conduct. Patients continued receiving care safely and efficiently. The data speaks for itself.
I’ll go one step further. A colleague of mine—a PA who spent 25 years in a private family practice—found himself solely responsible for an 8,000‑patient panel when his supervising physician was hospitalized in the ICU. Under the old rules, that practice would have shut its doors overnight. Instead, because New York wisely loosened supervisory requirements, those 8,000 patients continued receiving care from the clinician who knew their histories, their medications, and their families. That is what continuity looks like. That is what stability looks like. And that is what modernized PA practice protects.
Yet this article parrots AMA’s talking points almost word for word. I understand physicians are facing real pressures—loss of autonomy, declining trust, corporate consolidation, restrictive insurance policies, and burnout. I sympathize. But pretending that PAs are the problem is not serious policy thinking.
PAs are seeking greater autonomy for one simple reason: we are losing opportunities to independent NPs who do not require the added cost of a supervising physician. PAs are educated in a standardized, medical‑model curriculum at the graduate or post‑graduate level, with a single national certification board and mandatory continuing education. We are trained from day one to collaborate, communicate, and strengthen the care team—not replace it.
Modernizing PA practice helps physicians by offloading routine tasks and helps patients by improving timely access to both acute and preventive care. New York is fortunate to have a governor who understands this. Governor Hochul has consistently recognized the essential role of the more than 20,000 PAs who keep New Yorkers healthy. Her support for modernization—especially in rural and underserved areas—reflects a commitment to access, efficiency, and a resilient workforce. And even then, New York’s proposal is modest: limited autonomous practice in certain primary care settings only, then only after the PA has accumulated 8,000–10,000 hours of experience in that specialty, and still requiring physician collaboration.
As a retired PA with 40+ years of practice, I’ve seen how well collaborative care works when every member of the team is empowered to practice to the top of their training. That’s why it’s frustrating to see arguments that ignore both the evidence and the lived reality of today’s healthcare system.
Meanwhile, the AMA continues insisting on “physician‑only care,” even as physicians themselves cannot meet current demand. Why not work with Congress, CMS, state legislators, the AAPA, and others to build a system that uses the full healthcare workforce efficiently, cost‑effectively, and safely?
Until then, I’ll continue seeing my VA and community PAs—confident that my care team is outstanding.
Granted that most PAs should be supervised and not give diagnoses without a doctor. My wife and I had a good PA in 2019 through 2021. She mentored by a doctor we had known for many years and was in the process of getting her degree. When good old Covid struck, they immediately told their patients not to get the vaccine and gave their patients a combination of over-the-counter supplements that would be better than the vaccine. We had many friends who have had the vaccine get Covid over and over. Since taking the supplements, we have been fortunate to have remain well.
A PA, or a nurse practitioner, takes the time to listen to me, and call in the office doctor if it is beyond their knowledge, or genuinely needed. There aren’t that many doctors, they have too many patients to even recall who you are without looking at your file, they have limited time, seldom listen enough to find the root cause of your symptoms, and they make mistakes. This may be the only thing NY is getting right.
To tell the truth, I’ve never been seen by a PA. I’ve been seen by a lot of RNPs who for the most part have done a reasonably good job. There’s a little responsibility on you with this decision. Are you sick, chest pain, passing out, stroke symptoms, head ache, bleeding out, SOB, pain 5+ – really sick and need help – go to the ER. If you have doubts about who to go to, go to the ER. If it’s something you don’t think is serious but you need to see someone medical – go to the EC. I get it, it’s a cost thing. ECs are much less than ERs. But use EC for minor treatable stuff – to include Covid, they can prescribe the meds. In the ER you may be also seen by a PA or RNP but they have a Dr available to consult with when things don’t look right.