PROVIDENCE — Students hoping to become physician assistants, including House Speaker Nicholas Mattiello's son, are part of a push to expand the use of physician assistants in Rhode Island by giving them the legal freedom to care for patients outside the direct supervision of doctors.

A bill scheduled for a committee vote Wednesday would replace mandatory physician assistant supervision by medical doctors with "collaboration."

"This legislation makes it easier for physicians and physician assistants to work collaboratively together by eliminating unrealistic requirements," Anthony Mattiello, a second-year physician assistant student at Bryant University and son of the speaker, told the House Health Education and Welfare Committee in a hearing on the bill last month. "Not only will this bill make it easier to find employment, it will make it easier to volunteer and provide medical care to the uninsured and underserved population in Rhode Island."

Anthony Mattiello was joined by more than a dozen fellow students from Bryant's physician-assistant program attending the hearing in support of the bill, which has been proposed by the Rhode Island Academy of Physician Assistants.

But at least one group of physicians — dermatologists — doesn't like the idea of loosening doctors' legal position at the top of the medical pecking order.

In a joint letter to lawmakers, American Academy of Dermatology Association President George Hruza and Rhode Island Dermatology Society President H. William Higgins III said the bill would "jeopardize" the quality of dermatology "by eliminating the physician's role as leader of team-based care."

"Efforts to disassemble the physician-physician assistant relationship will further compartmentalize the delivery of health care," the letter says. "The optimal way to provide dermatologic care is under the direction of a board-certified dermatologist, who retains the ultimate responsibility for patient care and tasks delegated to care team members."

As the dermatologists note, doctors typically spend at least eight years in training (four in medical school plus internship and three years of residency) while physician assistants spend two years in school followed by 2,000 hours of clinical training.

With all this extra training, dermatologists are better at diagnosing skin cancer than physician assistants, the letter said, citing a study of University of Pittsburgh Medical Center patients.

Whether doctors in other well-paid medical specialties object to changing the physician-assistant law is unclear.

Dr. Steven Detoy, registered lobbyist for the Rhode Island Medical Society, signed up to testify in favor, but did not speak at the March hearing.

In addition to replacing doctors' legal supervisory role over physician assistants with a collaborative one, the bill, introduced by Rep. David Bennett, a registered nurse, would eliminate physician legal liability for the work of physician assistants.

James Carney, director for Advocacy and Government Relations for the R.I. Academy of Physician Assistants, told the committee the legislation would not expand the scope of work that physician assistants are allowed to do, or let assistants practice without doctors involved, but get rid of barriers to using assistants by better reflecting what they are already doing.

"[Physician assistants] were born out of a physician shortage; it is appropriate that now, during another physician shortage, that they be fully utilized — rather than held back by terminology that have inaccurately described their practice for some time now," Carney wrote to the committee. "This change does not diminish the importance of the healthcare team."

The Veterans Administration uses the "collaboration" model, he added, and similar language has been passed in New Mexico, Tennessee, Michigan and West Virginia.

A Senate version of the bill was introduced by Sen. Erin Lynch Prata.