Megan Zawacki started working at St. Peter’s Health in Helena, Montana, in 2020 as a physician assistant trained in treating addiction. She had gone through specialized training that allowed her to prescribe Suboxone, a medication to fight opioid addiction, but she couldn’t do so for six months.
That’s because Zawacki was hired to work with a doctor who specialized in addiction medicine, but that doctor did not join St. Peter’s until three months after Zawacki was hired, and it was another three months before he became her supervisor. Under Montana law, physician assistants must be supervised by a licensed physician, with a supervision agreement filed with the state Board of Medical Examiners.
Zawacki had an interim agreement that allowed her to begin work, but she needed that supervision agreement to prescribe Suboxone. While Zawacki was waiting, the only way her patients could get Suboxone was in the emergency room, where it costs more and comes in only a three-day supply. Zawacki said a three-day supply is meant to get a patient through withdrawal, but months of treatment are needed to end substance use.
“Any time that you’re limiting access to care, you’re putting patients at risk,” Zawacki said.
As Montana grapples with a health care provider shortage, state lawmakers are trying to find ways to increase access to care. One proposal up for debate is to give physician assistants like Zawacki more independence to practice unsupervised. Republican Rep. Jodee Etchart is sponsoring House Bill 313, which would let physician assistants practice without a supervision agreement. The bill is similar to laws in neighboring North Dakota and Wyoming.
Many physicians oppose the measure. Jean Branscum, CEO of the Montana Medical Association, said the bill expands a physician assistant’s scope of practice with no added training requirements.