Physician Assistants practice collaboratively with physicians just as physicians practice collaboratively with other physicians, meaning, the care team which consists of physicians, PAs, NPs, and other providers are all trained to seek assistance whenever needed.  Access is a major issue for patients everywhere, including the commonwealth.  Language like this creates additional access issues that patients should not be subject to.  We should be doing everything we can to increase access and not place requirements like this in the way of providing care.  There is absolutely no data to suggest this provides any safer care, in fact, there are many studies that show PAs provide care that is at least equal to the quality of care that is provided by our physician colleagues.