ED physician assistants not seen as very risky

While there is general agreement that temporary staff can threaten patient safety and increase malpractice risks, the question is not quite so clear with nurse practitioners (NPs) and physician assistants (PAs) in the emergency department (ED).

NPs and PAs are increasingly being used in EDs, with PAs treating about 10% of the total patient population that visit EDs each year, according to a recent study in the Journal of the American Academy of Physician Assistants.1 The study examined how physicians perceive PAs in the ED and whether they believe PAs to be a malpractice risk. Researchers mailed a 16-item questionnaire to a random sample of 1,000 active members of the American College of Emergency Physicians in 2004 and again five years later. Results from both surveys were fairly consistent.

The percentage of doctors who disagreed or strongly disagreed that PAs are more likely than physicians to commit medical malpractice was 72% in 2004 and 68% in 2009. Similarly, most physicians disagreed or strongly disagreed that PAs were more likely than doctors to be sued as a result of medical malpractice (84% in 2004, 82% in 2009).

According to the survey results, physicians in both surveys thought that the factors that would most significantly decrease the risk of malpractice by PAs were more clinical experience in emergency medicine, completion of a post-graduate residency program, and appropriate supervision by physicians.

Some positive trends were seen during the five-year period between surveys: The number of physicians who reported practicing with PAs increased by 26%, and the number of doctors who were directly supervising PAs in the ED increased by 19%. Even better, the number of physicians who believed that PAs decrease patient wait times in the ED increased by 13%, and the number of doctors who believe that PAs increase patient satisfaction increased by 10%.

Most emergency physicians agree that the increased utilization of PAs in the ED might improve patient communication, decrease wait times, increase patient satisfaction, and therefore decrease malpractice risk," the authors wrote. In addition, the authors concluded, "as physicians gain both clinical experience and experience working with PAs, their perception of malpractice risk imposed by the PA in the ED significantly decreases."

According to one medical liability study performed by the National Practitioner Data Bank (NPDB) in 2008, there were 1,535 reported medical malpractice payment incidents against PAs between 1991 and 2007. The average payout cost medical providers about $80,003. Although this number was significantly lower than reports and payments for physicians, there were multiple areas in which PAs made medical errors.

According to the NPDB study, the five major categories where PAs received the most malpractice reports were in the areas of diagnosis (55.5%), treatment (24.6%), medication (8.5%), surgery (4.6%) and miscellaneous (3.1%).


1. Gifford A, Hyde M, Stoehr JD. PAs in the ED: Do physicians think they increase the malpractice risk? J Amer Acad Physician Assistants 2011; 24:34, 36-38.