Duties Of Medical Assistants
In isolated Edgemont in southwestern South Dakota, Chesley is the only medical authority available for medical assistant classes. The nearest doctor is 25 miles away in Hot Springs, and the nearest full-service hospital is in Rapid City, 80 miles away.
As doctors and medical facilities have become increasingly scarcer in rural America, physician's assistants and nurse practitioners have become the front line of health care in thousands of tiny towns which offer medical assistant classes. A nurse practitioner is a nurse with advanced training who can perform routine health assessments.
"These folks can do roughly 80 percent of the work doctors do, and studies show they are extremely cost effective," said Robert Van Hook, director of the National Rural Health Association.
Physician's assistants, or PAs as the medical profession calls them, came about in the late 1980s, amid a shortage of doctors and a need to utilize military medics returning from Vietnam. The idea was for them to work close to, and under the direct physical supervision of, doctors. But in Edgemont and other places off the beaten track, it has not worked out that way. Despite a widely proclaimed national glut of doctors, in rural America there is an acute shortage. A severe curtailment of funds for the federal government's National Health Service Corps, which once provided doctors to rural areas, has contributed significantly to the problem. It was in South Dakota that the idea developed for using PAs as "independent site practitioners," as state medical authorities called them, working on their own in small, isolated towns, maintaining telephone and radio contact with supervising doctors, who may visit them once a week. About 125 PAs now practice in the state. State law allows them, among other things, to prescribe medication after diagnosis, perform emergency deliveries, sew sutures - except on the palm of the hand and sole of the foot - and X-ray all but the spine and the skull. They are prohibited from doing things that carry a high malpractice risk, such as removing foreign objects from an eye cornea. "I think at first some of our doctors might have felt threatened. Some were concerned that they might do something they're not trained to do," said Dr. Robert Hayes of Wall, S.D., a Vietnam War veteran who pioneered the use of PAs in South Dakota.
| 