· The U.S. faces a projected physician shortfall of up to 86,000 by 2036 (Association of American Medical Colleges [AAMC], 2024).

· Wisconsin is projected to face a shortfall of >25,000 health professionals by 2035 without bold action (Wisconsin Council on Medical Education and Workforce [WCMEW], 2024).

· WCMEW’s 2021 modeling found deficits across all physician specialties and documented PA license growth of +49% between 2014–2021 (WCMEW, 2024).

· The Wisconsin Hospital Association’s 2025 Workforce Report notes shortages remain 'serious, but stable,' with demand continuing to outpace growth (Wisconsin Hospital Association [WHA], 2025).

· HRSA projects a national shortfall of ~87,150 FTE primary-care physicians by 2037 (Bureau of Health Workforce, 2024).

· Two acute-care hospitals in western Wisconsin closed in March 2024 (Hospital Sisters Health System [HSHS], 2024).

· OB/Labor & Delivery closures across 11 rural hospitals (2009–2018) with further recent closures at Waupaca (2025) and Rice Lake (2024) (Wisconsin Office of Rural Health [WORH], 2018; Wisconsin Health News, 2025).

· The Wisconsin Hospital Association notes an 'obstetrical desert' emerging across parts of western Wisconsin (WHA, 2025).

· Chartis (2025) found 432 rural hospitals nationwide are vulnerable to closure; Wisconsin in the 1–9% at-risk bracket (Chartis, 2025).

· Marshfield Clinic Health System reported ~$152M operating loss in FY2024 amid rating agency pressure (Fitch Ratings, 2025).

· A 2023 Journal of Medical Regulation study found removing restrictive PA laws did not increase malpractice risk (Cawley et al., 2023).

· Malpractice reports (2005–2014) were 11.2–19.0 per 1,000 physicians vs. 1.4–2.4 for PAs (Kurtzman et al., 2017).

· A 2025 rapid review found PA/NP-led teams used fewer diagnostics and admissions with no adverse impact (Jones et al., 2025).

· No difference in diabetes outcomes by provider type across 568 VA facilities (Smith et al., 2018).

· Inpatient teams led by APPs, physicians, or residents showed comparable outcomes and costs (Kapu et al., 2020).

· PA/NP panels for complex diabetics had fewer hospitalizations/ED visits and lower total spending (Kuo et al., 2019).

· Diabetes management by PAs/NPs comparable to physicians over 4 years (Liu et al., 2018).

· VA data show costs/utilization comparable across provider types for diabetes patients (Smith et al., 2020).

· Nearly 80% rated PA care good/excellent; ~2/3 would choose a PA again (American Academy of Physician Associates [AAPA], 2023a).

· 91% of patients treated by a PA reported being very satisfied; 85% likely to see a PA again (National Commission on Certification of Physician Assistants [NCCPA], 2023a).

· Patients reported high satisfaction, rapport, and faster access with PAs (Gadbois et al., 2023).

· 59% of physicians report working with PAs/NPs, citing improved patient care and workflow efficiency (AAMC, 2024).

· 22.8% of PAs deliver care in HPSAs/MUAs (NCCPA, 2023b).

· PAs are more likely than physicians to work in under-resourced areas (Mullan et al., 2024).

· Removing barriers to PA practice improves access, cost-effectiveness, and safety (Cawley et al., 2024).

· New Hampshire HB 1222 Study Committee (2024) concluded PAs are rigorously educated, licensed clinicians providing safe, cost-effective care (NH Legislature, 2024).

· PAs complete 2–3 years of master’s-level, medical-model training (AAPA, 2023b).

· ARC-PA accreditation ensures breadth in medical knowledge, patient care, professionalism, and systems-based practice (Accreditation Review Commission on Education for the Physician Assistant [ARC-PA], 2023).

· Certification: PANCE pass rates >90%, with recertification and CME requirements ensuring continued competence (NCCPA, 2023c).

· PA education is highly selective: fewer than 20% of applicants admitted nationally (Physician Assistant Education Association [PAEA], 2023).

· In AAPA’s 2019 WPP survey, 90% of PA respondents reported a disconnect between the official title 'Physician Assistant' and their actual role (AAPA, 2019).

· In Kantar’s research, 71% of patients agreed the title 'Physician Associate' better matched the PA job description (The DO, 2021).

· In the same study, 65% of physicians also supported that 'Physician Associate' more accurately described the PA role (The DO, 2021).

· Drawing on this evidence, the AAPA House of Delegates voted in May 2021 to adopt 'Physician Associate' as the official title (AAPA, 2021).

· PA education and training are rigorous and competency-based.

· Evidence consistently shows PAs deliver high-quality, safe, and cost-effective care.

· Modernizing PA laws aligns with trends toward competency-based medical education, such as accelerated 3-year MD programs (AAMC, 2021).

1. Accreditation Review Commission on Education for the Physician Assistant. (2023). Accreditation standards. https://www.arc-pa.org/standards/

2. American Academy of Physician Associates. (2019, May 20). 90% of PAs cite disconnect between official title 'physician assistant' and their role in healthcare. https://www.aapa.org/news-central/2019/05/90-of-pas-cite-disconnect-between-official-title-physician-assistant-and-their-role-in-healthcare/

3. American Academy of Physician Associates. (2021, October 1). What your patients and healthcare colleagues should know about PA title change. https://www.aapa.org/news-central/2021/10/what-your-patients-and-healthcare-colleagues-should-know-about-pa-title-change/

4. American Academy of Physician Associates. (2023a). The Harris Poll: Patients agree PAs add value to U.S. healthcare system. https://www.aapa.org/news-central/2023/05/the-harris-poll-patients-agree-pas-add-value-to-u-s-healthcare-system/

5. American Academy of Physician Associates. (2023b). PA education overview. https://www.aapa.org/career-central/become-a-pa/

6. Association of American Medical Colleges. (2021). Three-year medical school programs. https://www.aamc.org

7. Association of American Medical Colleges. (2024). The complexities of physician supply and demand: Projections from 2021 to 2036. https://www.aamc.org

8. Bureau of Health Workforce. (2024). National Center for Health Workforce Analysis: Primary care projections. https://bhw.hrsa.gov

9. Cawley, J. F., Jones, P. E., & Miller, A. A. (2023). Medical malpractice payment reports of physician assistants and nurse practitioners. Journal of Medical Regulation, 109(4), 27–39. https://meridian.allenpress.com/jmr/article/109/4/27/498933

10. Cawley, J. F., Jones, P. E., & Miller, A. A. (2024). Removing barriers to PA practice improves patient access. Journal of Medical Regulation. https://www.globenewswire.com/news-release/2024/02/13/2828606/0/en/New-Study-Published-in-Journal-of-Medical-Regulation-Affirms-Removing-Barriers-to-PA-Practice-Improves-Patient-Access-to-High-quality-Care.html

11. Chartis. (2025). Rural hospital vulnerability index. https://chartis.com

12. Fitch Ratings. (2025). Marshfield Clinic Health System credit rating. https://www.fitchratings.com

13. Gadbois, E. A., et al. (2023). Primary care patient satisfaction with physician associates. Journal of Primary Care Research. https://pmc.ncbi.nlm.nih.gov/articles/PMC10623992/

14. Hospital Sisters Health System. (2024). Closure notices for Sacred Heart and St. Joseph’s hospitals. https://www.hshs.org

15. Jones, P. E., et al. (2025). Physician associate and nurse practitioner care quality: A rapid review. National Institutes of Health. https://pmc.ncbi.nlm.nih.gov/articles/PMC12225544/

16. Kapu, A. N., Kleinpell, R., & Pilon, B. (2020). Nurse practitioner and physician assistant hospitalist care. Journal of Hospital Medicine, 15(10), 561–568. https://shmpublications.onlinelibrary.wiley.com/doi/10.12788/jhm.3425

17. Kuo, Y. F., et al. (2019). Outcomes of medically complex patients managed by NPs and PAs. Health Affairs, 38(7), 1028–1035. https://www.healthaffairs.org/doi/10.1377/hlthaff.2019.00663

18. Kurtzman, E. T., Barnow, B. S., et al. (2017). Malpractice payment reports of NPs and PAs. Medical Care Research and Review, 74(5), 531–544. https://pubmed.ncbi.nlm.nih.gov/27457425/

19. Liu, C. F., et al. (2018). Diabetes management by advanced practice providers vs physicians. American Journal of Medicine, 131(8), 1008–1016. https://www.amjmed.com/article/S0002-9343(18)30177-6/fulltext

20. Mullan, F., et al. (2024). PA workforce distribution in underserved areas. Journal of Rural Health. https://pmc.ncbi.nlm.nih.gov/articles/PMC11282839/

21. National Commission on Certification of Physician Assistants. (2023a). Public opinion of PAs. https://www.nccpa.net/news/study-sheds-light-on-public-opinion-of-pas/

22. National Commission on Certification of Physician Assistants. (2023b). PAs address shortages in underserved areas. https://www.nccpa.net/news/pas-address-shortages/

23. National Commission on Certification of Physician Assistants. (2023c). Maintain certification and CME requirements. https://www.nccpa.net/maintain-certification/

24. New Hampshire Legislature. (2024). HB 1222 study committee report on physician assistants.

25. Physician Assistant Education Association. (2023). By the numbers: Program admissions and selectivity. https://paeaonline.org/research/by-the-numbers

26. Smith, V. A., et al. (2018). Patient outcomes by provider type in the VA system. Annals of Internal Medicine, 169(4), 236–244. https://pubmed.ncbi.nlm.nih.gov/29610835/

27. Smith, V. A., et al. (2020). Cost and utilization comparisons for diabetes care by provider type. Journal of Health Economics. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7412935/

28. The DO. (2021, September 23). 'Physician associate' title change: AAPA CEO discusses the switch. American Osteopathic Association. https://thedo.osteopathic.org/2021/09/physician-associate-title-change-aapa-ceo-discusses-the-switch/

29. Wisconsin Council on Medical Education and Workforce. (2024). Strategic plan: Health workforce projections. https://wcmew.org/reports/

30. Wisconsin Health News. (2025). ThedaCare–Froedtert closes Waupaca OB unit. https://www.wisconsinhealthnews.com

31. Wisconsin Hospital Association. (2025). Health care workforce report. https://www.wha.org

32. Wisconsin Office of Rural Health. (2018). Obstetrics unit closures in rural Wisconsin. Wisconsin Medical Journal.  Microsoft Word - Obstetric Services Report 2018_Revised.docx