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Fact Check: The Truth About PA Modernization

Since MAPA introduced the PA Modernization Act (HB5522) to the House Health Policy Committee, the Michigan State Medical Society (MSMS) has publicly opposed the bill. We take our physician colleagues’ perspectives seriously, and it’s important to address several misconceptions circulating about our legislation. The following points may help guide your responses to MSMS’s claims.

MSMS President Dr. Amit Ghose stated: “We’ve seen what happens in states that weaken physician-led teams. Patients experience more fragmented care, higher out-of-pocket costs, and increased emergency room visits.”

However, high‑quality evidence from large health systems consistently demonstrates that PAs provide care comparable to physicians on key quality, safety, and utilization metrics. Across primary care, hospital medicine, and emergency care, studies show:

● Comparable clinical outcomes. Patients with chronic conditions such as diabetes experience similar health outcomes regardless of whether they are managed by physicians, PAs, or NPs [1, 6].

● No increase in unnecessary utilization. Greater use of PAs in primary care is not associated with higher rates of specialty referrals, advanced imaging, ED visits, or hospitalizations [2].

● Equivalent safety and quality in acute care. In both hospitalist and emergency department settings, PA-led or PA‑integrated models deliver outcomes equivalent to physician-only models, often at lower cost and with appropriate physician consultation for higher-acuity cases [3, 4].

Addressing Claims About Access and "Lower Standards of Care"

MSMS has also asserted: “Expanding scope of practice for non-physicians does not meaningfully improve access — it simply lowers the standard of care at a time when families are already paying more and getting less.”

Evidence does not support this claim. 

● PAs and NPs improve access in underserved areas. In rural and medically underserved communities, PAs and NPs help offset physician shortages and strengthen local economies [5].

● PAs and NPs are part of the national strategy to address provider shortages. Research shows that PAs and NPs manage chronic diseases, including diabetes, with outcomes comparable to physicians [6].

 ● Federal agencies recommend modernizing scope laws. A joint report from HHS, Treasury, and Labor recommends that states remove unnecessary supervisory requirements and allow PAs to practice to the full extent of their training [7].

● Economists agree that restrictive scope laws are not based on safety. Policy experts from the American Enterprise Institute and Brookings Institution conclude that many scope restrictions are political rather than safety‑driven and should be removed when not supported by evidence [8].

● HB 5522 does not expand PA scope of practice. It modernizes outdated supervisory structures without changing education, certification, or regulatory standards. PAs are reimbursed at 85% of the physician rate, so families do not pay more for PA‑delivered care.

Patient Safety and Liability Data

Claims that modernizing PA practice threatens patient safety are not supported by national liability data.

● PAs have significantly lower malpractice rates than physicians. From 2005–2014, PAs averaged one malpractice payment for every 550 PAs, compared with one for every 80 physicians [10].

● Long‑term national data show PAs do not increase liability risk. Over 17 years of NPDB data, physicians were over ten times more likely than PAs to have a malpractice payment [11].

● Independent legal analysis supports modernizing PA practice. A 2024 review concludes that experienced PAs and NPs can safely practice independently, with no statistically significant differences in quality or safety when performing comparable services [12].

Reaffirming Team-Based Care

MSMS has also stated:

“If lawmakers are serious about addressing access and affordability, the answer isn’t to separate patients from physicians. The answer is to strengthen the team-based model that consistently delivers better outcomes. Michigan patients don’t want shortcuts when their health is on the line—they want care they can trust. Protecting physician-led care means protecting patient safety, and that must remain our priority.” 

HB 5522 preserves team-based care. It does not change PA scope of practice, education, or certification. It simply removes outdated supervisory structures that do not improve safety and often limit access—especially in rural and underserved communities.

Medical delivery has evolved, and our laws must evolve with it. Many lawmakers have expressed frustration with ongoing infighting among medical groups. MAPA agrees: it is time to put patients first.

MSMS should focus on graduating more physicians, expanding residency positions, and creating incentives for physicians to practice in Michigan. In the meantime, PAs stand ready to meet the needs of patients who are currently underserved by our healthcare system.

1. Jackson, G. L., et al. (2018). Intermediate Diabetes Outcomes in Patients Managed by Physicians, Nurse Practitioners, or Physician Assistants. Annals of Internal Medicine, 169(12), 825–835.
2. Liu, H., et al. (2017). The Impact of Using Mid-Level Providers in Face-to-Face Primary Care on Health Care Utilization. Medical Care, 55(1), 12–18.
3. Capstack, T. M., et al. (2016). A Comparison of Conventional and Expanded Physician Assistant Hospitalist Staffing Models. Journal of Clinical Outcomes Management, 23(10), 455–460.
4. Pavlik, D., et al. (2016). Physician Assistant Management of Pediatric Patients in a General Community Emergency Department. Pediatric Emergency Care.
5. Eilrich, F. C. (2016). The Economic Effect of a Physician Assistant or Nurse Practitioner in Rural America. JAAPA, 29(10), 44–48.
6. Yang, Y., Long, Q., et al. (2017). Nurse Practitioners, Physician Assistants, and Physicians Are Comparable in Managing the First Five Years of Diabetes. The American Journal of Medicine.
7. U.S. Departments of HHS, Treasury, and Labor. (2018). Reforming America’s Healthcare System Through Choice and Competition.
8. Antos, J., & Rivlin, A. (2019). A New Vision for Health Reform. American Enterprise Institute & Brookings Institution.
9. MSMS Public Statements (quoted).
10. U.S. Department of Health and Human Services. (2016). National Practitioner Data Bank.
11. Hooker, R. S., Nicholson, J. C., & Le, T. (2009). Does the Employment of Physician Assistants and Nurse Practitioners Increase Liability? Journal of Medical Licensure and Discipline, 95(2), 6–16.
12. Waxman & Dechene (2024). Expanding Scope of Practice for Nurse Practitioners and Physician Assistants to Enhance Healthcare. Annals of Health Law and Life Sciences, 33(1), 101–143.