Trends

Ophthalmology is slowly turning to Physician assistants

Few work in the field, but the need is growing.

Steven Lane, Fairfax, Virginia.

Kim Darden, the PA at Central Plains Eye MDs in Wichita, Kan., examines a patient.COURTESY OF CLARISSA GREENLEAF

The United States faces both a projected shortage of ophthalmologists and a near certain increase in the number of aging patients, who typically have more eye problems than the rest of the population. So we need to ask: Who will take care of the nation’s eyes in the future?

One solution may be for ophthalmologists to work with more physician assistants (PAs). PAs have the medical and surgical training to do a much of what ophthalmologists do, can bill for certain procedures and exams and have formed working partnerships with ophthalmologists across the country.

However, there are relatively few PAs working in ophthalmology today. This article looks at some reasons and explores what PAs can bring to an ophthalmology practice after appropriate training.

What can PAs do?

With so few in the specialty, it is difficult to generalize the responsibilities of an ophthalmic PA. The practice profile for most ophthalmic PAs can include any of the following:

■ Patient evaluations

■ Seeing emergency patients when the physician is unavailable

■ Handling preoperative and postoperative care

■ Performing angiograms

■ Managing treatment plans

■ Taking calls

■ Educating patients.

PAs who have worked with their physicians for many years can take on more patients and handle more advanced procedures. For example, Kim Darden, a PA with Central Plains Eye MDs in Wichita, Kan., reports performing more than 2,000 intravitreal injections without a single case of endophthalmitis.

On-the-job training

Like any new employee, PAs spend the first few months learning in the clinical setting. “If you take a PA fresh out of PA school, they are like a new MD before residency. They know next to nothing about ophthalmology,” says Mark Goldberg, MD, at the Eye Institute in Tulsa, Okla. “The best way for them to learn is to have their own patients.”

Like Dr. Goldberg, several ophthalmologists have invested the time needed to train a PA. “You have to take time to make the PA and yourself comfortable with the practice,” says Chirag Patel, MD, founder of Lake Nona Ophthalmology in Orlando, Fla. Once they are comfortable, “PAs can do so much in a comprehensive practice,” he says. “Having a PA around is like having a second you with you all day.”

Medical experience

The PA on Dr. Patel’s team, Krishma Patel, says her primary care background helps her treat patients in terms of systemic diseases that affect the eye, particularly diabetes. “I know the meds and understand what they are going through,” she says.

Kris Wyatt, the PA at the Eye Institute, sees 30 to 35 patients every day, including emergency patients, whom she evaluates and presents to Dr. Goldberg over the phone when he is in the OR.

Kris Wyatt, right, acts as a second set of hands to Mark Goldberg, MD, at the Eye Institute in Tulsa, Okla.
COURTESY OF CHRISTOPHER SMITH

“I am exactly what a PA should be,” she says. “I am him [the doctor] when he’s not in the room.”

Why so few PAs?

PAs are significantly underutilized in ophthalmology. According to the American Academy of Physician Assistants, there are only about 70 PAs currently working in ophthalmology, or one for every 270 of the more than 18,000 ophthalmologists in practice in the United States. By way of comparison, about 10,000 PAs work in emergency medicine, one for every 3.5 physicians and another 10,000 in orthopedic surgery, one for every 2.5 physicians in that specialty. Several PAs interviewed for this story believed they were the only PA working in ophthalmology in their state. Why do so few PAs work in ophthalmology?

One reason may be that PA students receive little specific eye training, so they may not develop an affinity for it. Linda Vorvick, MD, an academic coordinator at the University of Washington MEDEX PA Program in Seattle, says that her program “spirals” the material related to the eye, covering it in many areas of the curriculum — in anatomy and physiology, physical exam, and pathophysiology, among others — but that there is no concentrated section related to the eye. Her program offers an elective rotation in ophthalmology, but no student has yet taken it. She chalks this up to “a certain qualitative barrier to working with the eye. It’s different from the rest of the body. It’s a little bit scary because it’s so important,” she says.

Why should you hire a PA?

“We would love to use PAs like other specialties do,” says Rachel Reinhardt, MD, at Cascade Eye MDs in Mill Creek, Wash. Dr. Reinhardt has written a white paper for the AAO on the potential role of PAs in the specialty. Fundamentally, she says, it’s a matter of economics. “A PA brings more patients in the door and wait times go down.”

“It’s a steep learning curve, but once we get going, it’s worth it,” says Ms. Wyatt. OP

Steven Lane is a contract writer and editor for the American Academy of Physician Assistants.