Physician assistants have won the first round in an unusual push to rebrand themselves as physician associates. And doctors aren't amused.

Why it matters: The title change reflects PAs' growing prominence in the health care system amid a nationwide physician shortage, and dovetails with other efforts to increase PAs' autonomy.

• But critics say it blurs the lines between doctors and other health professionals, leaving patients confused and making it easier for PAs to pursue independent practice.

Driving the news: Oregon became the first state to legally sanction the change this month, allowing PAs starting in June to use the title on their license. Updated guidelines on coordinating and managing care will follow.

• Other states including Michigan and South Carolina are considering similar measures.
• PAs have been pushing for the recognition for years, but the effort has gained momentum post-pandemic, as more regions face shortages of primary care providers.
• The title change won't affect how PAs are paid, said Alisa Gifford, president of the Oregon Society of Physician Associates.

What they're saying: "Having a title that more accurately reflects our scope of practice will give patients a better understanding of the important credentials and responsibilities that PAs have," Gifford said.

• "Frankly, we get asked all the time, 'So you're a junior doctor, are you going to graduate from med school soon?'" she said. "It's important to show them that we're associates, we are professionals."

How it works: PAs have bachelor's degrees and go through graduate programs that typically involve about three years of coursework and clinical experience.

• In most states, they can diagnose patients, prescribe medicine and participate in surgery. About a quarter of PAs work as primary care providers, filling gaps in patient access as doctors become more specialized.

The big picture: Oregon's policy comes as the country trends toward autonomy for advance practice providers, said Eliza Dailey, director of physician and medical group research at Advisory Board.

• A number of states, including Oregon, already allow PAs to practice without a supervising physician.
• Employing a PA costs less than employing a doctor, and the profession is growing quickly. PAs and other advanced practice providers will outnumber physician primary care providers in all U.S. markets by 2031, according to Advisory Board modeling shared with Axios.

Context: In 2019, the national trade group for PAs hired a consulting firm to study alternative titles for physician assistants in an effort to upgrade the profession's brand.

• The association's delegates voted in 2021 to change the profession's name to physician associates and the group's own name to the American Association of Physician Associates.
• But in order for PAs to officially call themselves physician associates, the state they practice in must individually change its laws and regulations, said Lisa Gables, the group's CEO.

The other side: Physicians have long opposed what they view as scope of practice creep. The American Medical Association said AAPA's name change would confuse patients and was "incompatible with state laws."

• In Oregon, the state association for osteopathic doctors asked lawmakers to scrap the title-change legislation and convene a working group on the issue instead.
• The term "associate" "conflates the level of training and education of a PA," said Carmen Kavali, a Georgia-based doctor and president of physician-led care advocacy group Physicians for Patient Protection.
• Oregon's name change "is self-serving and is not patient-centric in any way," she wrote in an email.

Friction point: Not all PAs are crazy about the title change, either. Medscape found last year that 15% of PAs opposed the change, and 45% said they were neutral.

• Some PAs feel the time and money spent on lobbying, changing paperwork and rebranding graduate programs could be better spent elsewhere.
• The consulting firm that studied a title change reportedly estimated the move would cost the AAPA at least $22 million over five years. AAPA last year spent 8% of its budget to lobby states on issues including title change, Gables told Axios.

What's next: Michigan may soon follow Oregon's lead. A package of bills introduced last year would change PAs' title, allow them to supervise medical assistants and count them as mental health providers.

Editor's note: This story has been updated to clarify that AAPA spent 8% of its budget in 2023 to lobby states on issues including title change.