Abstract
Purpose. Access to health care services has been an issue that has driven public policy for years. Over the last ten years, access to care has come to the forefront of the legislative process. It has been the primary focus of federal and state legislators. Health access to health care services has been addressed from several perspectives, workforce distribution, immigration trends, and proposal of legislation which is tailored toward the previously mentioned areas. The purpose of this study was to review and analyze federal and state policies that have led to the development and implementation of legislation that impacts PAs' scope of practice in California, Maryland, and Texas. In addition, the study generates suggestions for further study, while documenting the author's research and analysis. Methodology. The study is a qualitative study that is based upon the principles that were set forth by Robert Yin. Three states were chosen for the study: California, Maryland, and Texas, based upon their demographic locations, population base, and ethnic composition. The data sources for the study were from secondary data and interviews and were primarily archival. There were nine phone interviews conducted. The information was transcribed and the results were analyzed using pattern matching and explanation building. These strategies were utilized to answer three research questions that dealt with (1) workforce maldistributions, (2) immigration trends and their ability to impact physician assistant (PA) practice options, (3) federal and state legislation that has enhanced or impeded the practice of PAs in the three study states. Findings. The findings of the study yielded six common patterns: (1) access to health care, (2) role confusions, (3) workforce planning, (4) prescriptive privileges, (5) size of the profession, (6) immigration trends. The information was gathered from a review of secondary data and the analysis of the interview responses. This study overwhelmingly demonstrated that these were the key issues that influenced how PAs gained practice rights within the study states. Recommendations. This study recommends that PAs as a profession need to be closely involved with the federal and state legislative process in order to insure that legislation is submitted that is responsive to their practice needs. In addition, the study recommends that federal and state legislators should include PAs in workforce planning and continue to fund the academic and clinical education of PAs within the study sites.