Most anyone who has received medical care from a doctor’s office, emergency room or hospital has encountered not only doctors and nurses, but also so-called “mid-level” providers, including Advanced Registered Nurse Practitioners (ARNPs) and Physician Assistants (PAs).

For some, primary care these days does not even involve a doctor directly, as many of us have come to view ARNPs and PAs as essentially fulfilling this role. This is due in part to a general shortage of primary care doctors and a general increase in demand for healthcare, particularly with so many additional insured patients under the Affordable Care Act. Additionally, we as a society of health care consumers have become more comfortable with PAs and ARNPs providing us this medical care.

In Washington the PA scope of practice is broad already. Like many states, PAs and ARNPs can do just about anything a doctor can do, other than surgery. They can diagnose illnesses, write prescriptions, and order diagnostic tests. While they necessarily have a supervising physician, that does not mean that the doctor is side by side with the PA during her work day. Rather, often it means, depending on the experience of the PA, the relationship between PA and doctor, and the complexity of care at involved, that the doctor is only overseeing the work done by the PA after the care has been provided.

In recent past, many states have increased the autonomy given to PAs to practice, resulting in an increase in the number of PAs, including in Washington. Expect this to continue as institutional providers look for ways to offer competent, but cheaper, health care to its patient population.