On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service . The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here . Stories and photos may be republished at no cost with proper attribution and a link back to KHI.org.

A regulation change that will lift the cap on the number of physician assistants that Kansas doctors can supervise drew patient safety concerns from urban legislators Thursday.

But one western Kansas senator said the change is vital for rural areas relying on physician assistants to make up for doctor shortages.

Kansas physicians are limited to supervising two physician assistants unless they work at a large medical facility like a hospital or appeal to the Kansas Board of Healing Arts.

Under legislation passed the last two years, the board has proposed new rules that would allow doctors to have unlimited physician assistants working with them at their primary practice and a total of three at any satellite locations where they practice less than 20 percent of the time.

Rep. John Carmichael, a Democrat from Wichita, raised the possibility of doctors taking into their practice more physician assistants than they could safely supervise. He floated 100 as an arbitrary example.

View larger photo

“That’s entirely permissible, with no direct board oversight or explanation as to why?” Carmichael asked during a meeting of the Legislature’s Joint Committee on Administrative Rules and Regulations. “Is that what we’re doing here?”

Kelli Stevens, general counsel for the Board of Healing Arts, said Carmichael’s scenario “theoretically” could happen under the new regulations. But with only about 1,000 physician assistants in the state, she deemed it unlikely.

She also said the board would continue to monitor physicians to ensure their practices were safe.

“Physicians and P.A.s must still be able to meet the standard of care,” Stevens said. “That supervision still has to be adequate.”

Sen. Ralph Ostmeyer, a Republican from Grinnell whose district stretches across much of northwest Kansas, said he understood his colleague’s safety concerns but urged the committee to be open to the board’s rule changes on physician assistants.

“This is a good source of health care for western Kansas,” Ostmeyer said. “We’ve struggled to get doctors.”

Sixteen Kansas counties were designated as primary care health professional shortage areas as of February 2014, reflecting that need for doctors in less-populated areas of the state.

Ostmeyer said he didn’t see much potential for doctors to abuse the rule and hire more physician assistants than they could safely supervise.

“This is a good source of health care for western Kansas. We’ve struggled to get doctors.” - Sen. Ralph Ostmeyer, a Republican from Grinnell

Stevens told the committee that the board still would be able to investigate doctors it thinks have overextended themselves.

Numbers alone won’t be the determining factor though, she said, noting that there’s currently no limit for the number of advanced practice registered nurses that doctors may have working with them.

“There are practitioners who color outside the lines, but I don’t think it’s a numbers problem,” Stevens said. “It’s more the adequacy of the supervision, and that’s why the board is requiring very, very detailed information and substantive analysis of that relationship with each and every P.A.”

Stevens said the board would balance the new flexibility for doctors with requirements for more detailed reports on how they deploy physician assistants.

When committee members asked for copies of the new reporting forms, Stevens said they would be available soon. She also said the Board of Healing Arts plans a public meeting on the new regulations Feb. 11.

Rep. Jim Ward, another Wichita Democrat on the committee, said some of the proposed regulation changes seemed to go beyond what the House Health and Human Services Committee thought it was authorizing when it passed the related bills.

“People from your agency stood up before a microphone similar to you today and assured us there would be as much or more supervision (of physicians assistants) … and the citizens of Kansas would not be placed in harm by having folks who may have good intention but not enough skill because they haven’t finished medical school,” Ward said. “I’m concerned that’s not the case after hearing some of these questions.”

Ostmeyer joined the other members of the committee in recommending that the board further scrutinize the proposed regulations before they're enacted to better ensure patient safety.

Carmichael said he understood the need for more physician assistants in western Kansas and by the end of the hearing the committee members were "on the same page."